Not Every Coronary Artery Calcium Is the Same
Implications of Novel Measurements for Clinical Practice?
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From the early studies of Agatston et al1 demonstrating that the computed tomography measured coronary artery calcification (CAC) is associated with obstructive coronary artery disease, CAC evolved to become one of the most robust markers of subclinical coronary atherosclerosis. Over the course of this development, it was demonstrated that CAC is a reliable method that can predict an extensive array of cardiovascular events,2 across a wide spectrum of baseline cardiovascular risk factors.3 This stout ability to predict events has led to the recognition of CAC measurement to resolve risk uncertainty by many international guidelines and expert consensus in asymptomatic individuals.4–6
See Article by Ferencik et al
Although the power of 0 (ie, CAC=0) is universally accepted to derisk, to date we have continued to pursue reductionist approaches to categorize varying patterns of underlying CAC burden. Most guidelines still interpret CAC as a binary variable, which should reclassify individuals to a high-risk category if above a certain threshold although the exact threshold is variable across guidelines (CAC>100, 300, 400, or 75th percentile). The traditional CAC score, also referred to as the Agatston score, used in most prognostic studies to date, is a simple technique that considers the area and density of CAC calcifications detected on the coronary arteries in an ECG-gated noncontrast computed tomography with well-defined acquisition parameters.1 Its structured image acquisition was planned to minimize image noise and allow the measurement …