Karsten Pohle

TL;DR: Four cases of aberrant origin of the left main coronary artery or left anterior descending coronary artery from the right sinus of Valsalva are presented, showing the common variations of this anomaly.

Abstract: Objective: To compare the presence and extent of coronary calcifications in young patients with first, unheralded acute myocardial infarction with matched controls without a history of coronary artery disease. Methods: In 102 patients under 60 years of age (19–59 years, mean 41 years; 88% male), electron beam tomography was done 1–14 days after acute myocardial infarction, before any coronary intervention. Coronary calcifications were quantified using the Agatston score. Age related calcium centiles were determined based on the Mayo Clinic “epidemiology of coronary calcification” study, and results were compared with a group of 102 controls without coronary artery disease, matched for sex, age, and risk factors. Results: Calcifications were present in 95.1% of patients with acute myocardial infarction and in 59.1% of controls (p = 0.008). The mean (SD) Agatston score was 529 (901) in the infarct patients versus 119 (213) in the controls (p < 0.001). An Agatston score above the 50th centile was present in 87.2% of infarct patients and 47.0% of controls (p = 0.006), and above the 90th centile in 60.7% of infarct patients and only 5.8% of controls (p = 0.001). Conclusions: In young patients with their first, unheralded acute myocardial infarction, the presence and extent of coronary calcium are significantly greater than in matched controls.

TL;DR: Overlapping cross-sections, especially in combination with volumetric scoring, significantly improved interscan reproducibility of EBT calcium quantification in a phantom study.