From the Guidelines
The Agatston score should be interpreted as follows: a score of 0 indicates no detectable calcium and suggests very low cardiovascular risk, scores of 1-10 indicate minimal calcification with low risk, 11-100 show mild calcification with moderate risk, 101-400 represent moderate calcification with increased risk, and scores above 400 indicate extensive calcification with high cardiovascular risk. This interpretation is based on the most recent and highest quality study available, which emphasizes the importance of considering the Agatston score in the context of a patient's age, sex, and other risk factors 1.
Key Points to Consider
- A CAC score of 0 Agatston units suggests very low cardiovascular risk, and statin therapy may be withheld or delayed, except in cigarette smokers and those with a strong family history of premature ASCVD or diabetes 1.
- A CAC score of 1 to 99 units favors statin therapy, especially in patients older than 55 years 1.
- For any patient, if the CAC score is at least 100 Agatston units or is at or above the 75th percentile, statin therapy is indicated unless otherwise deferred by the outcome of a clinician–patient risk discussion 1.
- The presence and severity of coronary artery calcium have been shown to be associated with the likelihood of benefit from statin therapy for ASCVD risk reduction 1.
Importance of Regular Follow-Up
Regular follow-up with a healthcare provider is essential to develop an appropriate prevention plan based on the specific Agatston score and overall risk profile. This allows for the implementation of risk reduction strategies, which may include lifestyle modifications (diet, exercise, smoking cessation) or medications like statins, tailored to the individual's needs.
Contextual Considerations
The Agatston score should be considered in the context of other risk factors, such as family history, LDL-C levels, metabolic syndrome, chronic kidney disease, and high-risk ethnicity. The score is valuable because coronary calcium strongly correlates with future cardiac events, though it doesn't directly measure arterial narrowing or blockages 1.
Clinical Decision Making
Clinical decision making should prioritize the patient's overall risk profile, incorporating the Agatston score along with other risk factors. This comprehensive approach ensures that the management plan is tailored to the individual's specific needs, aiming to reduce morbidity, mortality, and improve quality of life.
From the Research
Interpreting the Agatston Score
The Agatston score, also known as the Coronary Artery Calcium (CAC) score, is a measure of the amount of calcium in the coronary arteries, which is a marker of underlying atherosclerotic vascular disease 2, 3. The score is calculated based on the amount of calcium detected in the coronary arteries during a coronary computed tomography (CT) scan.
Agatston Score Categories
The Agatston score can be categorized into several levels, including:
- CAC score of 0, which indicates a low prevalence of obstructive coronary artery disease (CAD) 3
- CAC score of 1-400, which is considered mild to moderate and has uncertain prognostic significance 4
- CAC score ≥ 400, which is considered high and indicates a significant risk of CAD 5
Clinical Application
The Agatston score has several clinical applications, including:
- Ruling out ischemic cardiomyopathy in patients with heart failure, as a CAC score of 0 has a high specificity and positive predictive value for nonischemic causes 3
- Identifying patients at high risk of major adverse cardiac events, as a higher CAC score is associated with an increased risk of cardiac events 6
- Guiding treatment decisions, such as the use of statin therapy, as a CAC score of 0 may indicate a lower risk of CAD and reduce the need for aggressive treatment 4
Limitations and Controversies
There are several limitations and controversies surrounding the use of the Agatston score, including:
- The optimal cutoff value for significant CAD or cardiac event risk is still debated, with some studies suggesting a cutoff value of 300 or 400 4
- The prognostic significance of moderate CAC scores (1-400) is still uncertain 4
- The use of CAC scoring in combination with noninvasive cardiac imaging and risk assessment is recommended, but the benefit of moderate CAC values in predicting prognosis with subsequent treatment is still controversial 4
Key Points
- A CAC score of 0 indicates a low prevalence of obstructive CAD, but does not completely rule out the disease 2, 3
- A higher CAC score is associated with an increased risk of cardiac events 6
- The Agatston score should be used in combination with clinical risk assessment and noninvasive cardiac imaging to guide treatment decisions 4