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Coronary Artery Calcium Scoring
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Coronary artery calcium score (CACS)
          • Definitions

            • Deposition of calcium hydroxyapatite in coronary arteries
              • Coronary calcium is always in intima and hence associated with coronary atherosclerotic plaque
              • Possible exception: Patients with renal failure may develop medial calcification
            • NECT imaging and quantitative software are used to determine CACS (Agatston score)

          IMAGING

          • Radiographic Findings

            • Fluoroscopic Findings

              • CT Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Arad Y et al: Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol. 46(1):166-72, 2005. Erratum in: J Am Coll Cardiol. 58(17):1832, 2011
                                  2. Budoff MJ et al: Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 39(25):2401-8, 2018
                                  3. Lehmann N 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. 137(7):665-79, 2018
                                  4. Mitchell JD et al: Impact of statins on cardiovascular outcomes following coronary artery calcium scoring. J Am Coll Cardiol. 72(25):3233-42, 2018
                                  5. Hecht HS 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 Thorac Imaging. 32(5):W54-W66, 2017
                                  6. Chiles C et al: Association of coronary artery calcification and mortality in the national lung screening trial: a comparison of three scoring methods. Radiology. 276(1):82-90, 2015
                                  7. Erbel R 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. 56(17):1397-406, 2010
                                  8. Budoff MJ et al: Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 158(4):554-61, 2009
                                  9. Detrano R et al: Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 358(13):1336-45, 2008
                                  10. Fraker TD Jr et al: 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 50(23):2264-74, 2007. Erratum in: J Am Coll Cardiol. 50(23):e1, 2007
                                  11. Greenland P et al: ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 49(3):378-402, 2007
                                  12. Budoff MJ et al: Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 114(16):1761-91, 2006
                                  13. McClelland RL et al: Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 113(1):30-7, 2006
                                  14. Schmermund A et al: Natural history and topographic pattern of progression of coronary calcification in symptomatic patients: An electron-beam CT study. Arterioscler Thromb Vasc Biol. 21(3):421-6, 2001
                                  15. Agatston AS et al: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 15(4):827-32, 1990
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Coronary artery calcium score (CACS)
                                          • Definitions

                                            • Deposition of calcium hydroxyapatite in coronary arteries
                                              • Coronary calcium is always in intima and hence associated with coronary atherosclerotic plaque
                                              • Possible exception: Patients with renal failure may develop medial calcification
                                            • NECT imaging and quantitative software are used to determine CACS (Agatston score)

                                          IMAGING

                                          • Radiographic Findings

                                            • Fluoroscopic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Arad Y et al: Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol. 46(1):166-72, 2005. Erratum in: J Am Coll Cardiol. 58(17):1832, 2011
                                                                  2. Budoff MJ et al: Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 39(25):2401-8, 2018
                                                                  3. Lehmann N 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. 137(7):665-79, 2018
                                                                  4. Mitchell JD et al: Impact of statins on cardiovascular outcomes following coronary artery calcium scoring. J Am Coll Cardiol. 72(25):3233-42, 2018
                                                                  5. Hecht HS 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 Thorac Imaging. 32(5):W54-W66, 2017
                                                                  6. Chiles C et al: Association of coronary artery calcification and mortality in the national lung screening trial: a comparison of three scoring methods. Radiology. 276(1):82-90, 2015
                                                                  7. Erbel R 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. 56(17):1397-406, 2010
                                                                  8. Budoff MJ et al: Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 158(4):554-61, 2009
                                                                  9. Detrano R et al: Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 358(13):1336-45, 2008
                                                                  10. Fraker TD Jr et al: 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 50(23):2264-74, 2007. Erratum in: J Am Coll Cardiol. 50(23):e1, 2007
                                                                  11. Greenland P et al: ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 49(3):378-402, 2007
                                                                  12. Budoff MJ et al: Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 114(16):1761-91, 2006
                                                                  13. McClelland RL et al: Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 113(1):30-7, 2006
                                                                  14. Schmermund A et al: Natural history and topographic pattern of progression of coronary calcification in symptomatic patients: An electron-beam CT study. Arterioscler Thromb Vasc Biol. 21(3):421-6, 2001
                                                                  15. Agatston AS et al: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 15(4):827-32, 1990