{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T18:53:33Z","timestamp":1783536813477,"version":"3.55.0"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Medial arterial calcification (MAC) is well characterized in peripheral arteries, but its pathology-validated prevalence in the coronary circulation remains uncertain. Because intravascular imaging cannot routinely delineate the elastic laminae in advanced atherosclerotic lesions, deep intimal calcification (DIC) accumulating adjacent to the internal elastic lamina (IEL) may fundamentally mimic MAC. This study aimed to determine the strict pathology-validated prevalence of true coronary MAC and morphologically characterize DIC as a potential imaging mimic using a large-scale autopsy registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We evaluated 4508 histologic sections from 327 coronary arteries in 112 autopsy cases. To ensure accurate layer-specific differentiation, the IEL and external elastic lamina were precisely identified using Movat Pentachrome and EVG stains. The cohort was high-risk, featuring 85% cardiac deaths. Pathology-confirmed MAC was remarkably rare, present in only 1.0% of sections and 3.6% of patients. Strikingly, coronary MAC presented in two distinct morphological phenotypes. Three patients exhibited nodular MAC strictly co-existing with intimal nodules in severely stenotic segments, representing secondary mechanical protrusion from the intima. Conversely, only one patient exhibited isolated medial sheet calcification with minimal intimal narrowing, representing true primary medial disease. Notably, the IEL-overriding pattern occasionally seen in peripheral MAC was entirely absent. Meanwhile, DIC was significantly more prevalent, identified in 35.7% of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>True primary coronary MAC is exceptionally rare. Because dense acoustic shadowing clinically conceals secondary medial nodular protrusions in vivo, imaging-reported coronary \u2018MAC\u2019 almost exclusively represents DIC. Recognizing three distinct phenotypes\u2014DIC, secondary nodular protrusion, and the rare true M\u00f6nckeberg-type MAC\u2014is essential to accurately interpret clinical imaging findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeag076","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:06:48Z","timestamp":1778760408000},"source":"Crossref","is-referenced-by-count":2,"title":["Pathology-validated prevalence and clinical characteristics of coronary medial arterial calcification"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8107-7848","authenticated-orcid":false,"given":"Yuki","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5934-0427","authenticated-orcid":false,"given":"Sho","family":"Torii","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Aihara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norihito","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Shiozaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsukasa","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Akita University School of Medicine , 1-1-1 Hondo, Akita, Akita 010-8543 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ageo Central General Hospital , 1-10-10 Kashiwaza, Ageo, Saitama 362-8588 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3924-3256","authenticated-orcid":false,"given":"Tomoya","family":"Onodera","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shizuoka City Shizuoka Hospital , 10-93 Ote-machi, Aoi-ku, Shizuoka, 420-8630 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Egawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shizuoka City Shizuoka Hospital , 10-93 Ote-machi, Aoi-ku, Shizuoka, 420-8630 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, St.Marianna University Hospital , 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaho","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Omura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Masugi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Morino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Iwate Medical University , 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3694 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Ikari","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara, Kanagawa 259-1193 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6721-1342","authenticated-orcid":false,"given":"Gaku","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University School of Medicine , 377-2 Ohno-Higashi, Osaka-Sayama, Osaka ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026070813364335100_oeag076-B1","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.jacc.2021.06.049","article-title":"Medial arterial calcification. JACC State-of-the-Art Review","volume":"78","author":"Lanzer","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026070813364335100_oeag076-B2","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.amjcard.2017.01.022","article-title":"Coronary plaque characteristics in hemodialysis-dependent patients as assessed by optical coherence tomography","volume":"119","author":"Chin","year":"2017","journal-title":"Am J Cardiol"},{"key":"2026070813364335100_oeag076-B3","volume":"277","author":"Aihara K, Torii S, Nakamura N, Hozumi H, Shiozaki M, Sato Y, Yoshikawa M, Kamioka N, Ijichi T, Natsumeda M, Ohno Y, Kodama T, Onodera T, Mibiki Y, Ohtani H, Kametani R, Yoshikawa A, Nakamura N, Ikari Y, Nakazawa G.","year":"2024","journal-title":"Am Heart J"},{"key":"2026070813364335100_oeag076-B4","volume":"2","author":"Kato T, Torii S, Nakamura N, Aihara K, Terabe Y, Iida O, Tokuda T, Nakama T, Kawahara Y, Miyamoto J, Saito T, Kamioka N, Murakami T, Ijichi T, Natsumeda M, Tanaka S, Ohno Y, Nakazawa G, Watanabe H, Ikari Y.","year":"2023","journal-title":"JACC Adv"},{"key":"2026070813364335100_oeag076-B5","volume":"77","author":"Torii S, Sato Y, Otsuka F, Kolodgie FD, Jinnouchi H, Sakamoto A, Park J, Yahagi K, Sakakura K, Cornelissen A, Kawakami R, Mori M, Kawai K, Amoa F, Guo L, Kutyna M, Fernandez R, Romero ME, Fowler D, Finn AV, Virmani R.","year":"2021","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeag076\/68295083\/oeag076.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/6\/4\/oeag076\/68295083\/oeag076.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/6\/4\/oeag076\/68295083\/oeag076.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T17:36:49Z","timestamp":1783532209000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjopen\/article\/doi\/10.1093\/ehjopen\/oeag076\/8679141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":5,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjopen\/oeag076","relation":{},"ISSN":["2752-4191"],"issn-type":[{"value":"2752-4191","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,5,15]]},"article-number":"oeag076"}}