Coronary Artery Calcium Scoring: An Update of Recent Data and Clinical Role

Memduh DURSUNa , Eda CİNGÖZb
aİstanbul University Faculty of Medicine, Department of Radiology, İstanbul, Türkiye
bBağcılar Training and Research Hospital, Clinic of Radiology İstanbul, Türkiye

Dursun M, Cingöz E. Coronary artery calcium scoring: An update of recent data and clinical role. In: Bayraktaroğlu S, ed. Advances in Cardiovascular System Imaging. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.7-11.

ABSTRACT
Coronary artery calcium (CAC) scoring is increasingly recognized as a critical tool, readily accessible for stratifying cardiovascular risk, prognosticating outcomes, and guiding preventive interventions. Integrating the CAC score with existing risk algorithms enhances cardiovascular risk evaluations, facilitating clinical decisions. Current guidelines advocate for the use of CAC scoring in reclassifying risk levels and directing statin therapy for individuals over 40 with a 10-year coronary artery disease risk ranging from borderline to intermediate. Employing a systematic method to interpret CAC scoring not only ensures precise score calculation but also guarantees that incidental findings are appropriately managed. It is also essential to consider that the accuracy of calcium score calculations can be affected by factors including coronary artery motion, extracardiac calcifications, streak artifacts from adjacent metallic prostheses, and the inclusion of patients who have undergone previous coronary interventions such as stent or bypass graft placements.

Keywords: Coronary vessels; calcium; computed tomography

Referanslar

  1. Allison MA, Criqui MH, Wright CM. Patterns and risk factors for systemic calcified atherosclerosis. Arterioscler Thromb Vasc Biol. 2004;24(2):331-6. [Crossref]
  2. Demer LL, Tintut Y. Vascular calcification: pathobiology of a multifaceted disease. Circulation. 2008;117(22):2938-48. [Crossref]
  3. Khan SS, Navar AM. The Potential and Pitfalls of Coronary Artery Calcium Scoring. JAMA Cardiology. 2022;7(1):11-12. [Crossref]
  4. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr., Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827-32. [Crossref]
  5. D'Agostino RB, Sr., Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53. [Crossref]
  6. Goff DC Jr., Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49-73. [Crossref]
  7. Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98(3):177-84. [Crossref]
  8. Erbel R, Möhlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56(17):1397-406. [Crossref]
  9. McClelland RL, Jorgensen NW, Budoff M, et al. 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol. 2015;66(15):1643-53. [Crossref]
  10. Adelhoefer S, Uddin SMI, Osei AD, Obisesan OH, Blaha MJ, Dzaye O. Coronary Artery Calcium Scoring: New Insights into Clinical Interpretation-Lessons from the CAC Consortium. Radiol Cardiothorac Imaging. 2020;2(6):e200281. [Crossref]
  11. Whelton SP, Al Rifai M, Dardari Z, et al. Coronary artery calcium and the competing long-term risk of cardiovascular vs. cancer mortality: the CAC Consortium. Eur Heart J Cardiovasc Imaging. 2019;20(4):389-95. [Crossref]
  12. Dzaye O, Dudum R, Mirbolouk M, et al. Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium. J Cardiovasc Comput Tomogr. 2020;14(1):12-17. [Crossref]
  13. Hecht HS, Cronin P, Blaha MJ, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2017;11(1):74-84. [Crossref]
  14. Spahillari A, Zhu J, Ferket BS, et al. Cost-effectiveness of Contemporary Statin Use Guidelines With or Without Coronary Artery Calcium Assessment in African American Individuals. JAMA Cardiol. 2020;5(8):871-80. [Crossref]
  15. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol. 2018;72(4):434-47. [Crossref]
  16. Lehmann N, Erbel R, Mahabadi AA, et al. Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall). Circulation. 2018;137(7):665-79. [Crossref]
  17. Shemesh J, Apter S, Itzchak Y, Motro M. Coronary calcification compared in patients with acute versus in those with chronic coronary events by using dual-sector spiral CT. Radiology. 2003;226(2):483-8. [Crossref]
  18. Forbang NI, McClelland RL, Remigio-Baker RA, et al. Associations of cardiovascular disease risk factors with abdominal aortic calcium volume and density: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2016;255:54-8. [Crossref]