What is a CT Coronary Artery Calcium Heart Scan?
The coronary artery calcium heart scan is a CT scan of the heart that looks for areas of calcium in the arteries that supply the heart with blood. The amount of calcium detected is then added together to give a score. The more calcium there is, the higher the score. Calcium signifies calcified plaque in the heart arteries. Plaque is the substance that leads to blockages and when it bursts, known as plaque rupture, it is what leads to a heart attack. The point of the CT coronary artery calcium heart scan is to determine the cardiovascular risk of a person. The score is typically obtained in people who are otherwise healthy and don’t have symptoms to try and assess their risk.
What Do The CT Coronary Artery Calcium Scores Mean?
A calcium score of 0 means there is no calcified plaque in the arteries
A calcium score of 1-10 means minimal plaque
A calcium score of 11-100 means mild plaque
A calcium score of 101-400 means moderate plaque
A calcium score of >400 means severe plaque
What Do The CT Coronary Artery Calcium Scores Mean In Terms of Risk?
Many studies have examined in depth the prognostic significance of coronary artery calcium scores and their role in assessing risk. These are some of links from which the figures below were derived.
A calcium score of 0 is felt to be very low risk. The predicted chance of an event across studies is around 1-2% over 10 years. Of course that places people with a calcium score of zero in a low risk group.
A calcium score of 0-100 is still felt to be relatively low risk. With the predicted chance of an event over 10 years estimated to be around 2-6%
A calcium score of 101-400 signifies intermediate risk of an event. The predicted 10-year chance of an event is between 13-16%.
A calcium score of >400 signifies high risk of an event. The predicted 10-year chance of an event is between 22-29%.
A calcium score of >1000 signifies very high risk of an event. The predicted 10-year chance of an event is 37%.
CT Coronary Artery Calcium Scores In Diabetic Patients
In general, patients with diabetes are considered to be at higher cardiovascular risk than patients without diabetes. Patients with diabetes and a coronary artery calcium score greater than 0 are at higher risk than patients with similar scores and without diabetes. In patients with scores of 0, the risk is low even if patients have diabetes.
What To Do With Calcium Scores In Patients Without Symptoms?
The question often asked is should patients with higher than usual calcium scores have further testing such as stress tests. The higher the calcium score, the higher the risk of a stress test being positive. In patients with lower calcium scores and no symptoms, stress testing is generally not considered appropriate. In patients with higher scores, i.e. >400, stress testing may be more appropriate in cases. In general there is no good evidence to take patients with high calcium scores for invasive tests such as heart catheterization.
Exceptional article
Thanks for the information. Just received my score of 185 and my Doc is sending me to a cardiologist. A couple articles here have cleared or at least gave me an idea of what is happening. Thanks again, Randy
I am a 62 year old female and had a CT score of 254 almost 2 years ago with all the plaque being in my LAD. I was referred to a cardiologist who literally laughed at me. I am always at the lowest risk on the Framingham scale. I’m thin, exercise a lot, always had excellent lipids. I went to another cardiologist who said he specialized in preventive cardiology. He looked at his watch while I was talking, could tell he wasn’t interested. Another physician remarked that no one will be interested until I have symptoms. The problem is the first symptom is sometimes death. I have no bad health habits to change
Have always eaten right, exercised, no tobacco, etc. What to do??
I am a 47 yr old female. Not overweight. Not a smoker. No high cholesterol. No high blood pressure. I eat right and I exercise. I do however have type 1 diabetes and a family history of heart disease. I had calcium screening done on a whim and my score was 535. My stress test was normal. Had angiogram which showed my LAD was 80% blocked with hard concrete calcification! Had to return to the cath lab after being on special meds for 2 weeks when they performed rotablation and put 2 stents in my LAD. Dr said I would’ve been dead in a year if I didn’t find this! Everyone, especially women and those with genetic disposition to heart disease should have this basic screening. It could save your life!
To the Moderator: Where is my post?
Cindy, i remember your question and had given it a long answer i believe, there were actually a few questions on this post! The post had been transferred to a new platform i believe and the questions and answers must not have been copied! Ive passed this on to a moderator. Feel free to repost the question in the interim.
Hello , your articles are really helpful. I would like to share some medical reports of my father who experienced Chest pain radiating to left arm in January at rest.He is currently on Clopidogrel, statins, metoprolol. I would be really thankful if you could share your opinion and what treatment should be opted (I’m worried about RCA and high calcium score-424.5)
Blood investigation reports:
Gamma GT- 79
TSH- 5.060
Vitamin B12- 164
Homocysteine- 29.6
Lipid profile:
LDL(mg/dL)- 91
HDL(mg/dL)-35
Triglycerides(mg/dL)-250
VLDL(mg/dL)-23
Carotid IMT: Bilaterally normal
USG whole abdomen report: Grade 1 fatty changes in liver
– Cholelithiasis
CT Coronary Angiography
Findings:
• The coronary ostia are in their normal position.
The coronary anatomy is right dominant.
• LM and Left anterior descending: There is a soft plaque seen extending from the distal left main to the ostium of LAD, causing 40-50% stenosis in distal left main and significant 60-70% stenosis at the ostium of LAD. Multiple fibrocalcific plaques are noted in mid LAD causing diffuse luminal irregularity and mild areas of stenosis.
Distal LAD is normal in course and calibre.
D1 is a tortuous branch and shows minor soft plaque in proximal segment and is enhancing well with contrast.
•Circumflex is thin branch and is normal in course. There is no evidence of stenosis or plaque.
•Obtuse marginal arteries are normal in course and calibre. There is no evidence of plaque stenosis.
•Right Coronary artery: There are multiple tiny calcified plaques seen in proximal, mid and distal RCA. There is a soft plaque seen in mid RCA causing significant 90-95% stenosis seen.
Mild areas of stenosis are seen in proximal and distal RCA. Few non-obstructive calcified plaque are seen in proximal PLV branch; however, it is normal in course and calibre. Cardiac chambers are normal.
Ejection fraction: 64%
Calcium Score: 424.5 (LAD- 64.7 , RCA- 359.8)
• Pericardium is normal
• Aortic Valve and mitral valve appear normal.
No evidence of cusps thickening or calcification seen.
•Aortic root appears normal in dimension.
Please see the answer to the same post in the heart blockages section.
I am a 65 year old male. I have a history of heart attacks in men in the family on my paternal side. My 1st cousin (age 63) gave me a heads up on heart issues-he’s 5 weeks recovering from open heart surgery (aneurysm of the upper aorta). His father (my uncle) died of a massive heart attack at age 66. My younger brother died 12 years ago at age 51 of a heart attack. I had a vascular ultrasound which was normal except for mild plaque in the carotid arteries. Had a calcium score test done-total score of 656 with 560 attributed to the LAD. Dr. put me on 80 mg of lipitor. I have been on low dose aspirin for 3-4 yrs. Had stress test done today-normal, no irregularities. I see my cardiogist in one month. My thought is to strongly request an angiogram. Am I on the right track?
If the stress test is negative, particularly if exercise was used, its unlikely there is a physiologically significant blockage. In that case its difficult to justify angiography as there is no appropriate indication. Read the following articles and see if they help give you insight.
https://myheart.net/articles/stent-save-life/
https://myheart.net/articles/do-i-need-a-stress-test/
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
My 60 yr. old husband score is 309, total cholesterol 263, HDL 53, non smoking. Active.
The highest number for the score (223) was in his right coronary artery. Is this unusual? We’re very concerned and our seeing a cardiologist.
The total score is intermediate risk. If there are no symptoms then its likely no further testing is required and the most important thing is to treat risk factors. Its good you are seeking an evaluation from a cardiologist for risk stratification.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD