From the Research
Coronary calcium CT scores have limited utility in patients over 80 years old. While these scans effectively detect calcified plaque in coronary arteries, their prognostic value diminishes significantly in this age group because most elderly patients already have some degree of coronary calcification. In patients over 80, a high calcium score is expected and provides little additional risk stratification beyond what can be determined from traditional cardiovascular risk factors and clinical assessment. Furthermore, the management approach for these patients typically focuses on symptom control, quality of life, and weighing treatment benefits against risks rather than primary prevention based on calcium scores. The test may unnecessarily increase healthcare costs and radiation exposure without meaningfully changing clinical decisions. Instead, comprehensive geriatric assessment, functional status evaluation, and consideration of comorbidities and life expectancy should guide cardiovascular care in this population. Clinicians should focus on individualized approaches that consider the patient's overall health status, preferences, and goals of care rather than relying on calcium scoring for decision-making in the very elderly.
Some studies, such as the one published in the Journal of the American College of Cardiology 1, have highlighted the importance of coronary artery calcium scoring in assessing cardiovascular risk, but these findings may not be directly applicable to patients over 80 years old. Other studies, like the one published in the JAMA cardiology 2, have suggested that coronary artery calcium score may be a useful marker for discriminating between lower and higher coronary heart disease risk in older adults, but the utility of this test in patients over 80 remains limited.
Key points to consider when evaluating the utility of coronary calcium CT scores in patients over 80 include:
- The high prevalence of coronary calcification in this age group, which reduces the test's prognostic value
- The focus on symptom control and quality of life in this population, rather than primary prevention
- The potential for unnecessary healthcare costs and radiation exposure
- The importance of comprehensive geriatric assessment and individualized approaches to cardiovascular care.
Overall, the available evidence suggests that coronary calcium CT scores have limited utility in patients over 80 years old, and clinicians should exercise caution when interpreting these results in this age group 2.