From the Guidelines
Coronary artery calcification on chest CT is a significant finding that indicates the presence of coronary atherosclerosis and correlates with future cardiovascular event risk, and patients with this finding should undergo cardiovascular risk assessment and consider further cardiac evaluation, as recommended by the most recent study 1. The presence of coronary calcification is an independent predictor of death and major cardiac events, and it aids in improved risk stratification beyond conventional risk factor-based scores alone 1.
Key Points to Consider
- The extent of calcification helps stratify risk and guide preventive strategies, though not all calcified plaques will cause symptoms or require intervention.
- A positive calcium score can re-stratify asymptomatic patients with a family history of premature CAD to a high-risk category and can even reclassify those individuals without risk factors as higher risk than those with multiple risk factors but no coronary artery calcification 1.
- The Agatston score is used to quantify calcification, and it provides a more accurate measurement of calcification than a non-quantitative assessment.
- Patients with a coronary calcification score should discuss their findings with their primary care physician, who may refer them to a cardiologist for additional testing, such as a dedicated coronary calcium scoring CT scan, stress tests, or coronary angiography.
Management and Prevention
- Based on the patient's risk factors and calcium score, the doctor may recommend lifestyle modifications, such as diet, exercise, and smoking cessation, or medications, such as statins or aspirin.
- Regular follow-up with a healthcare provider is essential to monitor and manage cardiovascular health appropriately.
- The most recent study 1 provides the strongest evidence for the significance of coronary calcification on chest CT, and it should be used to guide clinical decision-making.
Risk Stratification
- The presence of coronary calcification is associated with an increased risk of cardiovascular events, and it can be used to stratify patients into different risk categories.
- The extent of calcification is directly related to the risk of cardiovascular events, with higher scores indicating a higher risk 1.
- Patients with a high coronary calcification score should be considered at high risk for cardiovascular events and should be managed accordingly.
From the Research
Significance of Coronary Calcification
The presence of coronary calcification on a computed tomography (CT) scan of the chest is a significant finding, as it is a marker of atherosclerosis and an independent risk factor for cardiac-related mortality 2, 3.
Association with Cardiac Outcomes
Coronary artery calcification is associated with an increased risk of myocardial infarction and mortality 3, 4. The presence and severity of coronary artery calcification are associated with cardiac outcomes and mortality 3.
Reporting of Coronary Calcification
Guidelines support the reporting of coronary artery calcification on thoracic CT scans 3. However, radiologist opinions vary, and coronary calcification may be under-reported 5.
Clinical Implications
The identification of coronary artery calcification on thoracic CT scans may identify patients with previously unknown coronary artery disease 3. For asymptomatic patients, this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications 3.
Prognostic Value
The absence of coronary calcification on a chest CT is associated with low cardiovascular events and good prognosis, while high CT calcium scores often result in a higher incidence of cardiovascular events and worse survival 6. Coronary Calcium Scoring (CCS) has prognostic relevance and incremental prognostic value over conventional risk stratification in asymptomatic patients with an intermediate risk for coronary artery disease 6.
Key Findings
- Coronary artery calcification is a frequent incidental finding on thoracic CT scans 3, 5.
- The presence of peripheral arterial disease is associated with increased odds of major adverse cardiovascular events (MACE) and/or cardiovascular death in patients with coronary artery calcification on incidental chest CT scans 4.
- Lipid-lowering therapy has a treatment effect on the composite outcome of MACE or cardiovascular death in patients with coronary artery calcification on incidental chest CT scans 4.