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JACC Cardiovasc Imaging. 2018 Jan;11(1):127-142. doi: 10.1016/j.jcmg.2017.10.012.

Coronary Artery Calcification and its Progression: What Does it Really Mean?

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Cardiovascular Pathology Institute, Gaithersburg, Maryland.
Cardiovascular Pathology Institute, Gaithersburg, Maryland; University of Maryland, School of Medicine, Baltimore, Maryland. Electronic address:


Coronary artery calcification is concomitant with the development of advanced atherosclerosis. Coronary artery calcification pathologically begins as microcalcifications (0.5 to 15.0 μm) and grows into larger calcium fragments, which eventually result in sheet-like deposits (>3 mm). This evolution is observed to occur concurrently with the progression of plaque. These fragments and sheets of calcification can be easily identified by radiography as well as by computed tomography and intravascular imaging. Many imaging modalities have proposed spotty calcification to be a predictor of unstable plaque and have suggested more extensive calcification to be associated with stable plaques and perhaps the use of statin therapy. We will review the pathology of coronary calcification in humans with a focus on risk factors, relationship with plaque progression, correlation with plaque (in)stability, and effect of pharmacologic interventions.


calcification; imaging; pathology; stable plaque; unstable plaque

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