Coronary artery calcium score: current status

Abstract

The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes.

Primary Prevention Statins in Older Adults: Personalized Care for a Heterogeneous Population

“…It takes 10 to 15 minutes to complete and exposes the patient to a very low radiation dose, an average of less than 1.5 mSv. 25 A CAC score is particularly useful in older adults when it is very low because it can help "de-risk" an individual who might otherwise seem to be an intermediate or high risk for ASCVD based on their age or other CV risks that are common with age (eg, hypertension). In these older patients, a CAC score of 0 is particularly useful because emerging evidence shows its utility in reclassifying risk and supporting decisions not to initiate statin therapy in adults aged up to 80 years.…”

“…A CAC is calculated using noncontrast cardiac computed tomography. It takes 10 to 15 minutes to complete and exposes the patient to a very low radiation dose, an average of less than 1.5 mSv . A CAC score is particularly useful in older adults when it is very low because it can help “de‐risk” an individual who might otherwise seem to be an intermediate or high risk for ASCVD based on their age or other CV risks that are common with age (eg, hypertension).…”

“…This consensus document was derived from six investigations, with a cumulative population of more than 27 000 patients, ranging from 45 to 96 years of age . Using these fixed cutpoints, a CAC score of 100 to 400 is consistent with moderate CVD risk, suggesting increased risk of future coronary events, such that this individual should possibly be reclassified as high risk . Older adults remain significantly underrepresented in this consensus statement, potentially limiting the generalizability of cutpoints to older adults and making future trials to corroborate or modify these recommendations likely.…”

Adding Coronary Calcium Score to Exercise Treadmill Test: An Alternative to Refine Coronary Artery Disease Risk Stratification in Patients with Intermediate Risk Chest Pain

“…Category-free net reclassification improvement (NRI) [12] was also assessed. For ease of practical interpretation in clinic, we assessed the sensitivity, specificity, positive and negative predictive values using guideline advocated cut-offs of calcium score 100 and 400 [13] in patients with low and non-low risk duke treadmill scores.…”

Precision Medicine Advancements Using Whole Genome Sequencing, Noninvasive Whole Body Imaging, and Functional Diagnostics

“…We identified a LOF variant, c.63dupA (p.Leu22fs) in the LMBRD1 gene, associated with methylmalonic aciduria and homocystinuria, cblF type (MIM, 277380), in a 61-year old female with a CAC score of 2963. The relative risk of coronary heart disease is estimated as 10.8 for individuals with CAC scores more than 1000 71,72 . However, this individual had a low 10-year risk Framingham score (<5%) which would not have led to a recommendation for a CT scan 73 .…”