Role of coronary artery calcium score in risk prediction and therapy guidance of asymptomatic individuals

Coronary CT angiography (CCTA) has emerged as a gatekeeper to rule out coronary artery disease (CAD), due to its high sensitivity and negative predictive value. Prior to CCTA a native calcium screening scan is acquired, which provides additional information about the coronary artery anatomy and cardiovascular risk prediction by measuring coronary artery calcification (CAC). Based on large population-based and cohort studies, zero CAC score is linked to low probability of cardiovascular events in the future. Moreover, zero CAC score is superior in the discrimination and risk reclassification when compared with other cardiovascular risk factors. CAC score can also help to identify those who are less likely to benefit from statin pharmacotherapy. Since CAC score has an important role in risk stratification and it is a cheap and widely accessible non-invasive imaging modality, the major guidelines have already incorporated CAC score for risk prediction and therapy guiding. However, these guidelines give slightly different recommendations. Therefore, this review aimed to introduce the CAC measurement and to summarize the prognostic role of CAC scoring in individualized risk prediction and guiding preventative therapies.