How to treat coronary artery calcification?

The human heart is the most important part, and the occurrence of coronary heart disease affects the normal operation of the heart. The human body will feel chest tightness and shortness of breath, and there will be pain in the front and back of the chest. I often feel weak, listless, and my heart beats irregularly. This situation often also leads to the problem of coronary artery calcification. Calcification indicates that calcification points have grown on the surface of the human heart, which requires timely treatment. How to treat coronary artery calcification? What are the treatments for coronary artery calcification?

1. Chest X-ray examination: mainly refers to X-ray image enhanced fluoroscopy. Due to its high density resolution, it is widely used to detect CAC. It appears as spots or strips. More extensive ones may run along the coronary arteries in the form of long strips or tracks. Enhanced fluoroscopy shows that calcification beats with the heart beat. Fluoroscopic CAC helps to differentiate ischemic from non-ischemic heart disease. However, its density resolution for detecting calcification is far from comparable to that of CT, and only a large number of high-density calcification foci can be seen.

2. Ultrasound: Intravascular ultrasound can display cross-sectional images of the coronary artery lumen, which can not only show the condition of wall thickening, but also observe the structural characteristics of the lumen; non-calcified fibrous plaques appear as strong echoes without sound shadows, while calcified foci appear as strong echoes with sound shadows.

3. Selective coronary angiography: Coronary angiography shows that the sensitivity and specificity of CAC are very poor.

4. Conventional CT and spiral CT: CT has high density resolution and is an effective means of examining CAC. Calcification of the blood vessel wall appears as a high-density shadow, and the CT value can reach over 200HU. However, its scanning speed is slow, there are many motion artifacts, and calcification of the aortic valve and mitral valve can be analyzed by imaging. The application of multi-slice spiral CT coronary artery calcification scoring in clinical practice is of great help in determining the degree of atherosclerosis and diagnosing coronary heart disease.

5. Ultra-high-speed CT (UFCT): The scanning speed of UFCT is at the millisecond level, which is much faster than conventional CT. It eliminates cardiac motion artifacts, makes it easy to detect CAC and can make accurate quantification. It is the best means to examine CAC and the most reliable method to evaluate the degree and range of coronary artery calcification in patients. It has important clinical value for the diagnosis of coronary heart disease. For patients with asymptomatic myocardial infarction, UFCT is of great value in detecting CAC.

The difficulty in early prevention of coronary heart disease events lies in the fact that the diagnostic examination methods currently used in clinical practice make it difficult to determine which patients are prone to coronary heart disease events and therefore require coronary angiography and other examinations and interventional treatments. Conventional risk factors and symptoms of coronary heart disease have relatively low specificity for diagnosing coronary heart disease and are only valuable in people at high risk of coronary heart disease events. Exercise testing is a method for predicting coronary heart disease events in asymptomatic people, but positive results are only seen when significant coronary artery stenosis causes myocardial ischemia. CAC can occur in early coronary atherosclerotic lesions without clinical symptoms and traditional risk factors, or in patients with obvious coronary artery stenosis. Clinically, the discovery of coronary artery calcification indicates the occurrence of atherosclerosis.

Based on coronary angiography, it is impossible to predict which stenoses will lead to sudden thrombotic occlusion. A certain lesion may evolve into complete obstruction, which depends less on the degree of stenosis and more on the nature of the plaque. Mature plaques are composed of a large number of lipid-phagocytic macrophages and smooth muscle cells, surrounded by a pool of extracellular lipids. Plaques are often covered with fibrous caps of varying degrees to separate the contents of the plaque from the blood. Rupture of the fibrous cap can lead to thrombosis, causing the plaque to enlarge. In some cases, the blood clot dissolves quickly, the ruptured fibrous cap is repaired, and the enlarged plaque returns to its static state; over time, the hematoma becomes organized and calcified.

Calcification of the coronary artery wall often occurs in the hematoma of atherosclerotic plaques, smooth non-complex plaques have less calcification, and CAC with simple medial sclerosis without atherosclerotic lesions is relatively rare. CAC can occur in early coronary atherosclerotic lesions without clinical symptoms and traditional risk factors, and can also occur in patients with obvious coronary artery stenosis. Undoubtedly, CAC is a sign of coronary atherosclerosis and the basis for early diagnosis of coronary heart disease. It is a more meaningful diagnostic and treatment standard for coronary atherosclerosis than coronary artery stenosis. Calcified lesions are also considered to be a very important risk factor for failure of interventional procedures and acute occlusion. The detection of CAC has guiding significance for the selection of surgical and interventional treatments for coronary heart disease.