medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-165medsovet-10179Research ArticleАТЕРОСКЛЕРОЗATHEROSCLEROSISСостояние коронарных артерий у пациентов с острым ишемическим инсультом в зависимости от наличия повреждения миокардаStatus of coronary arteries in patients with acute ischemic stroke depending on the presence of myocardial injuryhttps://orcid.org/0000-0002-8633-7012КомароваА. Г.KomarovaA. G.

Комарова Анна Григорьевна, к.м.н., заместитель главного врача по медицинской части 

125284, Москва, 2-й Боткинский проезд, д. 5

Anna G. Komarova, Cand. Sci. (Med.), Deputy Chief Medical Offier 

5, 2nd Botkinskiy Proezd, Moscow, 125284

komarowa.4a@yandex.ruhttps://orcid.org/0000-0003-3929-431XШаваровА. А.ShavarovA. A.

Шаваров Андрей Анатольевич, к.м.н., доцент, старший научный сотрудник 

125284, Москва, 2-й Боткинский проезд, д. 5

Andrey A. Shavarov, Cand. Sci. (Med.), Associate Professor, Senior Researcher

5, 2nd Botkinskiy Proezd, Moscow, 125284

shavarov@yahoo.comhttps://orcid.org/0000-0002-8254-2625ЯковлевС. А.YakovlevS. A.

Яковлев Сергей Алексеевич, врач ультразвуковой диагностики 

125284, Москва, 2-й Боткинский проезд, д. 5

Sergey A. Yakovlev, Ultrasound Diagnostics Doctor 

5, 2nd Botkinskiy Proezd, Moscow, 125284

yakovlev.s.2507@yandex.ruhttps://orcid.org/0000-0001-9794-0696АстаповичЕ. Ю.AstapovichE. Yu.

Астапович Евгения Юрьевна, врач-кардиолог 

125284, Москва, 2-й Боткинский проезд, д. 5

Evgeniya Yu. Astapovich, Cardiologist 

5, 2nd Botkinskiy Proezd, Moscow, 125284

astapovich_ey@mail.ruhttps://orcid.org/0000-0003-1781-9496КривошееваН. М.KrivosheevaN. M.

Кривошеева Наталья Михайловна, к.м.н., заведующая неврологическим отделением 

125284, Москва, 2-й Боткинский проезд, д. 5

Natalia M. Krivosheeva, Cand. Sci. (Med.), Head of Neurological Department 

5, 2nd Botkinskiy Proezd, Moscow, 125284

virus207@mail.ruМосковский многопрофильный научно-клинический центр имени С.П. БоткинаРоссияBotkin HospitalRussian Federation20262506202607172180Copyright © Комарова А.Г., Шаваров А.А., Яковлев С.А., Астапович Е.Ю., Кривошеева Н.М., 20262026Комарова А.Г., Шаваров А.А., Яковлев С.А., Астапович Е.Ю., Кривошеева Н.М.Komarova A.G., Shavarov A.A., Yakovlev S.A., Astapovich E.Y., Krivosheeva N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10179Введение

Введение. До 60% пациентов с ишемическим инсультом (ИИ) имеют повышение уровня высокочувствительного сердечного тропонина (вчТн), однако в настоящее время сохраняется неопределенность причин и последствий данного феномена.

Цель

Цель. Оценить частоту обструктивного коронарного атеросклеротического поражения и кальциевый индекс (КИ) при выполнении компьютерной ангиографии коронарных артерий (КТКА) у пациентов с ИИ в зависимости от наличия повреждения миокарда, а также ассоциации между клинико-лабораторными параметрами и отсутствием кальциноза коронарных артерий.

Материалы и методы

Материалы и методы. В рамках проспективного регистрового исследования 50 пациентам (медиана возраста 60 (52; 66) лет) с подтвержденным ИИ была выполнена КТКА. Высокочувствительный тропонин-I определялся при поступлении и повторно в течение 48 ч.

Результаты

Результаты. При КТКА не были обнаружены гемодинамически значимые стенозы у 8 (44,4%) из 18 пациентов с острым повреждением миокарда, у 3 (33,3%) из 9 пациентов с хроническим повреждением и у 15 (65,3%) из 23 пациентов без повреждения миокарда. КИ в группах лиц с и без повреждения миокарда был сопоставим: 143 (0; 266) против 68 (4; 205) соответственно (р = 0,662). Уровни вчТн в категориях риска ишемической болезни сердца (ИБС) в зависимости от величины КИ не имели статистически значимых различий. В многофакторном регрессионном анализе у пациентов с ИИ изменение (D) вчТн с пороговым значением менее -2 нг/л увеличивало отношение шансов отсутствия кальциноза коронарных артерий в 5,931 раза (95%-ный доверительный интервал 1,129–31,150; р = 0,035).

Выводы

Выводы. Около половины пациентов с ИИ и острым повреждением миокарда, 1/3 пациентов с хроническим повреждением и почти 2/3 пациентов без повреждения миокарда не имели обструктивной ИБС. Абсолютное изменение вчТн в динамике независимо ассоциировалось с отсутствием кальциноза коронарных артерий у пациентов с ИИ.

Aim

Aim. To assess the frequency of obstructive coronary artery disease (CAD) and coronary calcium score (CCS) measured by coronary computed tomography angiography (CTCA) in patients with IS depending on the presence of myocardial injury (MI), the association between clinical and laboratory parameters and the absence of coronary calcification.

Materials and methods

Materials and methods. In a prospective registry study, 50 patients (median age 60 (52; 66) years) with confirmed IS underwent CTCA. HsTn-I was obtained on admission and repeated within 48 hours.

Results

Results. CTCA did not detect significant coronary stenoses in 8 (44.4%) of 18 patients with acute MI, in 3 (33.3%) of 9 patients with chronic MI, and in 15 (65.3%) of 23 patients without MI. In patients with and without MI a CCS was comparable: 143 (0; 266) vs 68 (4; 205), respectively (p = 0.662). There was no statistically significant difference between hsTn levels in CCS categories of CAD risk. In multivariate regression analysis in patients with IS a change (D) in hsTn with a cutoff value of less than -2 ng/L increased odds ratio for absence of coronary calcification by 5.931 times (95% confidence interval 1.129–31.150; p = 0.035).

Conclusions

Conclusions. About half of patients with IS and acute MI, 1/3 of patients with chronic MI, and almost 2/3 of patients without MI did not have obstructive CAD. Absolute change in hsTn was independently associated with the absence of coronary calcification in patients with IS.

ишемический инсульткоронарный атеросклерозтропонинповреждение миокардакомпьютерная ангиография коронарных артерийиндекс Агатстонаischemic strokecoronary atherosclerosistroponinmyocardial injurycoronary computed tomography angiographyAgatston indexReferencesProsser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke. 2007;38(8):2295–2302. https://doi.org/10.1161/STROKEAHA.106.471813.Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke. 2007;38(8):2295–2302. https://doi.org/10.1161/STROKEAHA.106.471813.Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol. 2018;17(12):1109–1120. https://doi.org/10.1016/S1474-4422(18)30336-3.Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol. 2018;17(12):1109–1120. https://doi.org/10.1016/S1474-4422(18)30336-3.Басанцова НЮ, Шишкин АН, Тибекина ЛМ. Цереброкардиальный синдром и его особенности у пациентов с острыми нарушениями мозгового кровообращения. Вестник Санкт­Петербургского университета. Медицина. 2017;12(1):31–47. https://doi.org/10.21638/11701/spbu11.2017.103.Basantsova NY, Shishkin AN, Tibekina LM. Cerebral-cardiac syndrome and its manifestation after acute stroke. Vestnik of Saint Petersburg University. Medicine. 2017;12(1):31–47. (In Russ.) https://doi.org/10.21638/11701/spbu11.2017.103.Kerr G, Ray G, Wu O, Stott DJ, Langhorne P. Elevated troponin after stroke: a systematic review. CED. 2009;28(3):220–226. https://doi.org/10.1159/000226773.Kerr G, Ray G, Wu O, Stott DJ, Langhorne P. Elevated troponin after stroke: a systematic review. CED. 2009;28(3):220–226. https://doi.org/10.1159/000226773.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038.Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988;12(6):1400–1406. https://doi.org/10.1016/s0735-1097(88)80002-0.Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988;12(6):1400–1406. https://doi.org/10.1016/s0735-1097(88)80002-0.Patil AR, Zheng A, Israel Y, Shah A, El-Eshmawi A, Pandis D et al. Computed tomography coronary angiography as an alternative to invasive coronary angiography in preoperative evaluation for mitral surgery. J Thorac Cardiovasc Surg. 2025;170(5):1422–1425. https://doi.org/10.1016/j.jtcvs.2024.12.035.Patil AR, Zheng A, Israel Y, Shah A, El-Eshmawi A, Pandis D et al. Computed tomography coronary angiography as an alternative to invasive coronary angiography in preoperative evaluation for mitral surgery. J Thorac Cardiovasc Surg. 2025;170(5):1422–1425. https://doi.org/10.1016/j.jtcvs.2024.12.035.Andreini D, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M et al. Atrial fibrillation: diagnostic accuracy of coronary CT angiography performed with a whole-heart 230-µm spatial resolution CT scanner. Radiology. 2017;284(3):676–684. https://doi.org/10.1148/radiol.2017161779.Andreini D, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M et al. Atrial fibrillation: diagnostic accuracy of coronary CT angiography performed with a whole-heart 230-µm spatial resolution CT scanner. Radiology. 2017;284(3):676–684. https://doi.org/10.1148/radiol.2017161779.Dewey M, Rief M, Martus P, Kendziora B, Feger S, Dreger H et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. BMJ. 2016;355:i5441. https://doi.org/10.1136/bmj.i5441.Dewey M, Rief M, Martus P, Kendziora B, Feger S, Dreger H et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. BMJ. 2016;355:i5441. https://doi.org/10.1136/bmj.i5441.Журавлев КН, Стяжкина ОВ, Васильева ЕЮ, Синицын ВЕ, Шпектор АВ. Диагностическая ценность низкодозной компьютерной томографии органов грудной клетки для расчета кальциевого индекса по сравнению со стандартной методикой и с результатами компьютерной томографии и селективной коронарографии. Российский кардиологический журнал. 2019;(12):16–21. https://doi.org/10.15829/1560-4071-2019-12-16-21.Zhuravlev KN, Styazhkina OV, Vasilieva EYu, Sinitsyn VE, Shpektor AV. The diagnostic value of low-dose chest computed tomography for calcium score determining compared with the standard method and the results of computed tomography and selective coronary angiography. Russian Journal of Cardiology. 2019;(12):16–21. (In Russ.) https://doi.org/10.15829/1560-4071-2019-12-16-21.Radford NB, DeFina LF, Barlow CE, Lakoski SG, Leonard D, Paixao AR et al. Progression of CAC score and risk of incident CVD. JACC Cardiovasc Imaging. 2016;9(12):1420–1429. https://doi.org/10.1016/j.jcmg.2016.03.010.Radford NB, DeFina LF, Barlow CE, Lakoski SG, Leonard D, Paixao AR et al. Progression of CAC score and risk of incident CVD. JACC Cardiovasc Imaging. 2016;9(12):1420–1429. https://doi.org/10.1016/j.jcmg.2016.03.010.Ilangkovan N, Mogensen CB, Mickley H, Lassen AT, Lambrechtsen J, Sand NPR et al. Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints. BMJ Open. 2018;8(3):e018391. https://doi.org/10.1136/bmjopen-2017-018391.Ilangkovan N, Mogensen CB, Mickley H, Lassen AT, Lambrechtsen J, Sand NPR et al. Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints. BMJ Open. 2018;8(3):e018391. https://doi.org/10.1136/bmjopen-2017-018391.Bellia C, Agnello L, Lo Sasso B, Milano S, Bivona G, Scazzone C et al. Fetuin-A is associated to serum calcium and AHSG T256S genotype but not to coronary artery calcification. Biochem Genet. 2016;54(3):222–231. https://doi.org/10.1007/s10528-016-9714-4.Bellia C, Agnello L, Lo Sasso B, Milano S, Bivona G, Scazzone C et al. Fetuin-A is associated to serum calcium and AHSG T256S genotype but not to coronary artery calcification. Biochem Genet. 2016;54(3):222–231. https://doi.org/10.1007/s10528-016-9714-4.Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, Jukema JW et al. High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants. J Am Coll Cardiol. 2017;70(5):558–568. https://doi.org/10.1016/j.jacc.2017.05.062.Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, Jukema JW et al. High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants. J Am Coll Cardiol. 2017;70(5):558–568. https://doi.org/10.1016/j.jacc.2017.05.062.Muscente F, De Caterina R. New insights from the MESA study: increased high-sensitivity troponins as a cardiovascular risk factor. Eur Heart J Suppl. 2021;23(Suppl. E):E68–E72. https://doi.org/10.1093/eurheartj/suab092.Muscente F, De Caterina R. New insights from the MESA study: increased high-sensitivity troponins as a cardiovascular risk factor. Eur Heart J Suppl. 2021;23(Suppl. E):E68–E72. https://doi.org/10.1093/eurheartj/suab092.Rusnak J, Behnes M, Henzler T, Reckord N, Vogler N, Meyer M et al. Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography assessed calcium scoring represented by the Agatston score. Eur J Med Res. 2017;22(1):47. https://doi.org/10.1186/s40001-017-0290-9.Rusnak J, Behnes M, Henzler T, Reckord N, Vogler N, Meyer M et al. Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography assessed calcium scoring represented by the Agatston score. Eur J Med Res. 2017;22(1):47. https://doi.org/10.1186/s40001-017-0290-9.Adams HPJr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.str.24.1.35.Adams HPJr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.str.24.1.35.Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999;30(8):1538–1541. https://doi.org/10.1161/01.str.30.8.1538.Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999;30(8):1538–1541. https://doi.org/10.1161/01.str.30.8.1538.Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte MJr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–832. https://doi.org/10.1016/0735-1097(90)90282-t.Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte MJr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–832. https://doi.org/10.1016/0735-1097(90)90282-t.Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999;74(3):243–252. https://doi.org/10.4065/74.3.243.Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999;74(3):243–252. https://doi.org/10.4065/74.3.243.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44–е122. https://doi.org/10.1016/j.jacc.2011.08.007.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44–е122. https://doi.org/10.1016/j.jacc.2011.08.007.Sui Y, Liu T, Luo J, Xu B, Zheng L, Zhao W et al. Elevation of high-sensitivity cardiac troponin T at admission is associated with increased 3-month mortality in acute ischemic stroke patients treated with thrombolysis. Clin Cardiol. 2019;42(10):881–888. https://doi.org/10.1002/clc.23237.Sui Y, Liu T, Luo J, Xu B, Zheng L, Zhao W et al. Elevation of high-sensitivity cardiac troponin T at admission is associated with increased 3-month mortality in acute ischemic stroke patients treated with thrombolysis. Clin Cardiol. 2019;42(10):881–888. https://doi.org/10.1002/clc.23237.He L, Wang J, Dong W. The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol. 2018;18(1):118. https://doi.org/10.1186/s12883-018-1121-5.He L, Wang J, Dong W. The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol. 2018;18(1):118. https://doi.org/10.1186/s12883-018-1121-5.Domienik-Karlowicz J, Kupczynska K, Michalski B, Kaplon-Cieslicka A, Darocha S, Dobrowolski P et al. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J. 2021;28(2):195–201. https://doi.org/10.5603/CJ.a2021.0036.Domienik-Karlowicz J, Kupczynska K, Michalski B, Kaplon-Cieslicka A, Darocha S, Dobrowolski P et al. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J. 2021;28(2):195–201. https://doi.org/10.5603/CJ.a2021.0036.Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32(4):404–411. https://doi.org/10.1093/eurheartj/ehq456.Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32(4):404–411. https://doi.org/10.1093/eurheartj/ehq456.Mochmann HC, Scheitz JF, Petzold GC, Haeusler KG, Audebert HJ, Laufs U et al. Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: the troponin elevation in acute ischemic stroke (TRELAS) study. Circulation. 2016;133(13):1264–1271. https://doi.org/10.1161/CIRCULATIONAHA.115.018547.Mochmann HC, Scheitz JF, Petzold GC, Haeusler KG, Audebert HJ, Laufs U et al. Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: the troponin elevation in acute ischemic stroke (TRELAS) study. Circulation. 2016;133(13):1264–1271. https://doi.org/10.1161/CIRCULATIONAHA.115.018547.Antoniades C, West HW. Coronary CT angiography as an ‘one-stop shop’ to detect the high-risk plaque and the vulnerable patient. Eur Heart J. 2021;42(37):3853–3855. https://doi.org/10.1093/eurheartj/ehab538.Antoniades C, West HW. Coronary CT angiography as an ‘one-stop shop’ to detect the high-risk plaque and the vulnerable patient. Eur Heart J. 2021;42(37):3853–3855. https://doi.org/10.1093/eurheartj/ehab538.Oluleye OW, Folsom AR, Nambi V, Lutsey PL, Ballantyne CM. Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality. Ann Epidemiol. 2013;23(2):66–73. https://doi.org/10.1016/j.annepidem.2012.11.004.Oluleye OW, Folsom AR, Nambi V, Lutsey PL, Ballantyne CM. Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality. Ann Epidemiol. 2013;23(2):66–73. https://doi.org/10.1016/j.annepidem.2012.11.004.Bansal N, Hyre Anderson A, Yang W, Christenson RH, deFilippi CR, Deo R et al. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Soc Nephrol. 2015;26(4):946–956. https://doi.org/10.1681/ASN.2014010108.Bansal N, Hyre Anderson A, Yang W, Christenson RH, deFilippi CR, Deo R et al. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Soc Nephrol. 2015;26(4):946–956. https://doi.org/10.1681/ASN.2014010108.Lo-Kioeng-Shioe MS, Rijlaarsdam-Hermsen D, van Domburg RT, Hadamitzky M, Lima JAC, Hoeks SE, Deckers JW. Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34000 subjects. Int J Cardiol. 2020;299:56–62. https://doi.org/10.1016/j.ijcard.2019.06.003.Lo-Kioeng-Shioe MS, Rijlaarsdam-Hermsen D, van Domburg RT, Hadamitzky M, Lima JAC, Hoeks SE, Deckers JW. Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34000 subjects. Int J Cardiol. 2020;299:56–62. https://doi.org/10.1016/j.ijcard.2019.06.003.Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, Ungprasert P, Sigurdsson G, Nabi F et al. Prognostic value of coronary artery calcium score in acute chest pain patients without known coronary artery disease: systematic review and meta-analysis. Ann Emerg Med. 2016;68(6):659–670. https://doi.org/10.1016/j.annemergmed.2016.07.020.Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, Ungprasert P, Sigurdsson G, Nabi F et al. Prognostic value of coronary artery calcium score in acute chest pain patients without known coronary artery disease: systematic review and meta-analysis. Ann Emerg Med. 2016;68(6):659–670. https://doi.org/10.1016/j.annemergmed.2016.07.020.Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology. 2014;264(3):637–649. https://doi.org/10.1148/radiol.12110810.Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology. 2014;264(3):637–649. https://doi.org/10.1148/radiol.12110810.Choi HY, Shin SJ, Yoo J, Lee K, Song D, Kim YD et al. Coronary calcium score for the prediction of asymptomatic coronary artery disease in patients with ischemic stroke. Front Neurol. 2020;11:206. https://doi.org/10.3389/fneur.2020.00206.Choi HY, Shin SJ, Yoo J, Lee K, Song D, Kim YD et al. Coronary calcium score for the prediction of asymptomatic coronary artery disease in patients with ischemic stroke. Front Neurol. 2020;11:206. https://doi.org/10.3389/fneur.2020.00206.Beatty AL, Ku IA, Christenson RH, DeFilippi CR, Schiller NB, Whooley MA. High-sensitivity cardiac troponin T levels and secondary events in outpatients with coronary heart disease from the Heart and Soul Study. JAMA Intern Med. 2013;173(9):763–769. https://doi.org/10.1001/jamainternmed.2013.116.Beatty AL, Ku IA, Christenson RH, DeFilippi CR, Schiller NB, Whooley MA. High-sensitivity cardiac troponin T levels and secondary events in outpatients with coronary heart disease from the Heart and Soul Study. JAMA Intern Med. 2013;173(9):763–769. https://doi.org/10.1001/jamainternmed.2013.116.Everett BM, Brooks MM, Vlachos HE, Chaitman BR, Frye RL, Bhatt DL, Group BDS. Troponin and cardiac events in stable ischemic heart disease and diabetes. N Engl J Med. 2015;373(7):610–620. https://doi.org/10.1056/NEJMoa1415921.Everett BM, Brooks MM, Vlachos HE, Chaitman BR, Frye RL, Bhatt DL, Group BDS. Troponin and cardiac events in stable ischemic heart disease and diabetes. N Engl J Med. 2015;373(7):610–620. https://doi.org/10.1056/NEJMoa1415921.Byrne RA, Rossello X, Coughlan JJ, Coughlan JJ, Barbato E, Berry C et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023;44(38):3720–3826. https://doi.org/10.1093/eurheartj/ehad191.Byrne RA, Rossello X, Coughlan JJ, Coughlan JJ, Barbato E, Berry C et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023;44(38):3720–3826. https://doi.org/10.1093/eurheartj/ehad191.Аверков ОB, Арутюнян ГК, Дупляков ДВ, Константинова ЕВ, Никулина НН, Шахнович РМ и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2024. Российский кардиологический журнал. 2025;30(5):6319. https://doi.org/10.15829/1560-4071-2025-6319.Averkov OV, Harutyunyan GK, Duplyakov DV, Konstantinova EV, Nikulina NN et al. 2024 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation electrocardiogram. Russian Journal of Cardiology. 2025;30(5):6319. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6319.Willeit K, Boehme C, Toell T, Tschiderer L, Seekircher L, Mayer-Suess L et al. High-sensitivity cardiac troponin T and cardiovascular risk after ischemic stroke or transient ischemic attack. JACC Adv. 2024;3(7):101022. https://doi.org/10.1016/j.jacadv.2024.101022.Willeit K, Boehme C, Toell T, Tschiderer L, Seekircher L, Mayer-Suess L et al. High-sensitivity cardiac troponin T and cardiovascular risk after ischemic stroke or transient ischemic attack. JACC Adv. 2024;3(7):101022. https://doi.org/10.1016/j.jacadv.2024.101022.Paana T, Jaakkola S, Bamberg K, Saraste A, Tuunainen E, Wittfooth S et al. Cardiac troponin elevations in marathon runners. Role of coronary atherosclerosis and skeletal muscle injury. The MaraCat Study. Int J Cardiol. 2019;295:25–28. https://doi.org/10.1016/j.ijcard.2019.08.019.Paana T, Jaakkola S, Bamberg K, Saraste A, Tuunainen E, Wittfooth S et al. Cardiac troponin elevations in marathon runners. Role of coronary atherosclerosis and skeletal muscle injury. The MaraCat Study. Int J Cardiol. 2019;295:25–28. https://doi.org/10.1016/j.ijcard.2019.08.019.Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. 2009;2(6):675–688. https://doi.org/10.1016/j.jcmg.2008.12.031.Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. 2009;2(6):675–688. https://doi.org/10.1016/j.jcmg.2008.12.031.Budoff MJ, McClelland RL, Nasir K, Greenland P, Kronmal RA, Kondos GT et al. Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2009;158(4):554–561. https://doi.org/10.1016/j.ahj.2009.08.007.Budoff MJ, McClelland RL, Nasir K, Greenland P, Kronmal RA, Kondos GT et al. Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2009;158(4):554–561. https://doi.org/10.1016/j.ahj.2009.08.007.Mouden M, Timmer JR, Reiffers S, Oostdijk AH, Knollema S, Ottervanger JP et al. Coronary artery calcium scoring to exclude flow-limiting coronary artery disease in symptomatic stable patients at low or intermediate risk. Radiology. 2013;269(1):77–83. https://doi.org/10.1148/radiol.13122529.Mouden M, Timmer JR, Reiffers S, Oostdijk AH, Knollema S, Ottervanger JP et al. Coronary artery calcium scoring to exclude flow-limiting coronary artery disease in symptomatic stable patients at low or intermediate risk. Radiology. 2013;269(1):77–83. https://doi.org/10.1148/radiol.13122529.Staniak HL, Bittencourt MS, Sharovsky R, Benseñor I, Olmos RD, Lotufo PA. Calcium score to evaluate chest pain in the emergency room. Arq Bras Cardiol. 2013;100(1):90–93. https://doi.org/10.1590/s0066-782x2013000100014.Staniak HL, Bittencourt MS, Sharovsky R, Benseñor I, Olmos RD, Lotufo PA. Calcium score to evaluate chest pain in the emergency room. Arq Bras Cardiol. 2013;100(1):90–93. https://doi.org/10.1590/s0066-782x2013000100014.Gottlieb I, Miller JM, Arbab-Zadeh A, Dewey M, Clouse ME, Sara L et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. 2010;55(7):627–634. https://doi.org/10.1016/j.jacc.2009.07.072.Gottlieb I, Miller JM, Arbab-Zadeh A, Dewey M, Clouse ME, Sara L et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. 2010;55(7):627–634. https://doi.org/10.1016/j.jacc.2009.07.072.Peix A, Batista E, Cabrera LO, Rodríguez L, Padrón K, Saínz B et al. GatedSPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram. Coron Artery Dis. 2012;23(7):438–444. https://doi.org/10.1097/MCA.0b013e3283576a13.Peix A, Batista E, Cabrera LO, Rodríguez L, Padrón K, Saínz B et al. GatedSPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram. Coron Artery Dis. 2012;23(7):438–444. https://doi.org/ 10.1097/MCA.0b013e3283576a13.Gajurel BP, Nepal G, Jaiswal V, Ang SP, Nain P, Shama N et al. Utilization rates of intravenous thrombolysis for acute ischemic stroke in Asian countries: a systematic review and meta-analysis. Medicine. 2023;102(42):e35560. https://doi.org/10.1097/MD.0000000000035560.Gajurel BP, Nepal G, Jaiswal V, Ang SP, Nain P, Shama N et al. Utilization rates of intravenous thrombolysis for acute ischemic stroke in Asian countries: a systematic review and meta-analysis. Medicine. 2023;102(42):e35560. https://doi.org/10.1097/MD.0000000000035560.Del Castillo García S, Garriz II, Coloma CG, Manso JV, Corral Fernandez JF, Rodríguez DA, Vázquez FF. Coronary artery calcium score in patients with non-ST-segment elevation acute coronary syndrome. REC: CardioClinics. 2025;60(3):167–175. https://doi.org/10.1016/j.rccl.2025.02.002.Del Castillo García S, Garriz II, Coloma CG, Manso JV, Corral Fernandez JF, Rodríguez DA, Vázquez FF. Coronary artery calcium score in patients with non-ST-segment elevation acute coronary syndrome. REC: CardioClinics. 2025;60(3):167–175. https://doi.org/10.1016/j.rccl.2025.02.002.Suh EH, Probst MA, Tichter AM, Ranard LS, Amaranto A, Chang BC et al. Flexible-interval high-sensitivity troponin velocity for the detection of acute coronary syndromes. Am J Cardiol. 2023;203:240–247. https://doi.org/10.1016/j.amjcard.2023.06.080.Suh EH, Probst MA, Tichter AM, Ranard LS, Amaranto A, Chang BC et al. Flexible-interval high-sensitivity troponin velocity for the detection of acute coronary syndromes. Am J Cardiol. 2023;203:240–247. https://doi.org/10.1016/j.amjcard.2023.06.080.

The authors declare that there are no conflicts of interest present.