The Doctor Weighs In

by Bill Bestermann, MD

I recently recorded “New Measurements Such as the Coronary Calcium Score Can Determine the Risk for Heart Attack” with Dr. George Lundberg at the American Heart Association Annual Scientific Sessions in Orlando. I want to thank my colleagues at “The Doctor Weighs In” for making this possible for me. The invitation to submit the editorial came directly from a blog entitled "New Technology to Determine Risk of Heart Attack" that I had written in this space that was posted in October 2007 and I would refer you to that piece for more detail on this topic. The video editorials are all very brief and present the idea in its most condensed form. You can access this video editorial at The Doctor Weighs In Video Editorials.

The knowledge surrounding unstable plaque continues to move forward rapidly. Recent studies of the coronary arteries using intravascular ultrasound examination of all three major vessels at the time of acute myocardial show multiple plaque ruptures. On average, patients had two active lesions with some patients having as many as 6 recent plaque ruptures. On coronary angioscopy, vulnerable arterial surfaces appear yellow and these lesions are very widely distributed in the coronary artery system leading to the concept of pan-coronary arteritis or multifocal plaque rupture.

A study of 48 thrombi in 50 ruptured coronary plaques in 30 patients showed that healing was slow and clot was persistent. When patients were re-examined at 13 months, 35 of the 48 thrombi were still present and only 23 of the ruptured plaques were healed. As these plaques healed there was a progression of fixed stenosis. The serum CRP was lower in the healed plaque rupture patients than in those whose arterial injuries had not healed. All of this supports the concept of a diffuse and dynamic process that is best approached with optimal medical therapy.

Keywords: coronary, angioscopy, plaques, stenosis, calcium score, arteritis, measurements, pan-coronary.