Coronary artery calcium scoring
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
Coronary Artery Calcium Scoring
The Agatston score is is a scoring system that uses images obtained from a non-contrast CT. It is determined by the number of calcific lesions, the area of each lesion and the peak HU of each lesion detected. The score for every calcific lesion is based on its density score and area (mm2).[1]
The density score is determined by the peak HU and is as follows:
- 1 = 130 - 199 HU
- 2 = 200 - 299 HU
- 3 = 300 - 399 HU
- 4 = >399 HU
If a lesion had a peak HU of 250 and an area of 4 mm2, it would receive a score of 8.
The CAC is the sum of the scores assigned to each calcific lesion.
The severity of the coronary artery calcification is is as follows:[2]
| Coronary Artery Calcium Score | Calcification Grade |
|---|---|
| 0 | None |
| 0-10 | Minimum |
| 11-100 | Mild |
| 101-400 | Moderate |
| >400 | Severe |
Role of CAC score in Clinical Practice
Current Guidelines
| Guideline | Recommendation | ||
|---|---|---|---|
| Class | Level of Evidence | ||
| 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk [3] | If after quantitative risk assessment, a risk-based decision is uncertain, one or more of the following tools may be used to aid in decision making: family history, hs-CRP, CAC score or ABI. | IIb | B |
| 2016 European Guidelines on Cardiovascular Disease Prevention In Clinical Practice [4] | CAC may be considered as a risk factor in CV risk assessment in patients with a calculated SCORE risk between 5% to 10%. | IIb | B |
| Recommendation | |||
| ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR
2010 Appropriate Use Criteria for Cardiac Computed Tomography [5] |
CAC would be appropriate in patients with a 10-20% 10-year risk of CHD. | Appropriate | |
| CAC would be appropriate in low risk patients (<10% 10-year risk of CHD) with a family history of premature CHD. | Appropriate | ||
| The usefulness of CAC is uncertain in patients with peripheral arterial disease or other coronary risk equivalents, or have a 10-year CHD risk greater than 20%, or who are 40 or older with diabetes. | Uncertain | ||
| CAC would be inappropriate in low risk patients (<10% 10-year risk of CHD). | Inappropriate | ||
References
- ↑ Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990). "Quantification of coronary artery calcium using ultrafast computed tomography". J Am Coll Cardiol. 15 (4): 827–32. PMID 2407762.
- ↑ van der Bijl N, Joemai RM, Geleijns J, Bax JJ, Schuijf JD, de Roos A; et al. (2010). "Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary angiography". AJR Am J Roentgenol. 195 (6): 1299–305. doi:10.2214/AJR.09.3734. PMID 21098187.
- ↑ Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R; et al. (2014). "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. 129 (25 Suppl 2): S49–73. doi:10.1161/01.cir.0000437741.48606.98. PMID 24222018.
- ↑ Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL; et al. (2016). "2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)". Eur Heart J. 37 (29): 2315–81. doi:10.1093/eurheartj/ehw106. PMC 4986030. PMID 27222591.
- ↑ Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P; et al. (2010). "ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance". J Cardiovasc Comput Tomogr. 4 (6): 407.e1–33. doi:10.1016/j.jcct.2010.11.001. PMID 21232696.