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The role of calcification in coronary artery disease is gaining importance, both in research studies and in clinical application. Calcified plaque has long been considered to be the most important atherosclerotic plaque within the arterial tree and frequently presents a challenge for percutaneous intervention. Current investigations have shown that plaque calcification has a dynamic course that is closely related to the magnitude of vascular inflammation. Numerous inflammatory factors synthesized during the early stages of atherosclerosis induce the expression and activation of osteoblast-like cells localized in the arterial wall that produce calcium. There is no doubt that the role of these factors in calcification associated with coronary artery disease could be a crucial strategic point in prevention and treatment. A number of diagnostic imaging methods have been developed in recent years, but their performance needs to be improved. In this context, we undertook an update on coronary calcification, focusing on physiopathology, clinical implications, and imaging techniques.

Introduction: Monitoring of disease activity and the best therapeutic approach are a challenge in Takayasu arteritis (TA). When associated with acute coronary syndromes (ACS), the best interventional treatment has not been established. The objective of this study was to describe the baseline characteristics, clinical manifestations, treatment and long-term outcome of patients with TA and ACS. Methods: We retrospectively analyzed eight patients between 2004 and 2010. The following data were obtained: age, gender, clinical and electrocardiographic manifestations, Killip class, risk factors for ACS, markers of myocardial necrosis (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate [ESR]), medication during hospital stay, angiographic findings, treatment (medical, percutaneous or surgical) and long-term outcome. Statistical data were expressed as percentages and absolute values. Results: All eight patients were women, median age 49 years. Typical chest pain was present in 37.5%. Elevated ESR was observed in 85.7%. Three patients underwent coronary artery bypass grafting, three underwent percutaneous coronary angioplasty (two with bare-metal stents and one with a drug-eluting stent) and two were treated medically. In-hospital mortality was 25%. There were no deaths during a mean follow-up of 30 months. Conclusions: In our study, patients who were discharged home had good outcomes in long-term follow-up with medical, percutaneous or surgical treatment. ESR appears to be associated with ACS in TA. Resumo: Introdução: A monitoração da atividade da doença e o melhor esquema terapêutico ainda têm sido um desafio em pacientes com arterite de Takayasu (AT). Em síndromes coronárias agudas (SCA) a melhor forma de tratamento intervencionista mantém-se indefinido. Dessa forma, descrevemos as características basais, manifestações clínicas, achados angiográficos, tratamento definitivo adotado e a evolução a longo prazo de pacientes com AT que apresentaram SCA. Métodos: Entre 2004 e 2010, foram analisados retrospectivamente 8 pacientes com AT que apresentaram SCA. As seguintes informações foram obtidas: idade, sexo, manifestações clínicas e eletrocardiográficas, estado hemodinâmico, fatores de risco para SCA, marcadores de necrose miocárdica, clearance de creatinina, fração de ejeção de ventrículo esquerdo, marcadores inflamatórios, medicações utilizadas, achados angiográficos, tratamento definitivo adotado e evolução a longo prazo. Resultados: Os 8 pacientes eram mulheres. A mediana de idade foi 49 anos. Dor precordial típica esteve presente em 37,5%. Cerca de 85,7% apresentaram aumento de velocidade de hemossedimentação. O seguimento mais acometido foi o tronco da coronária esquerda em 62,5%. Em 3 casos optou-se por revascularização cirúrgica, em 2 pacientes realizou-se angioplastia com stent convencional, em 1 com stent farmacológico e em 2 doentes manteve-se tratamento clínico. Obteve-se mortalidade intra-hospitalar de 25% e em seguimento médio de 30 meses não houve mortes. Conclusão: Em pacientes que sobreviveram ao quadro agudo e receberam alta hospitalar, bons resultados a longo prazo foram obtidos principalmente com tratamento clínico ou cirúrgico. A velocidade de hemossedimentação parece estar mais relacionada à ocorrência de quadros de SCA em pacientes com AT. Keywords: Takayasu arteritis, Acute coronary syndromes, Coronary angioplasty, Inflammation, Palavras-chave: Arterite de Takayasu, Síndrome coronária aguda, Angioplastia coronária, Inflamação