Author + information
- Received April 11, 2017
- Revision received May 6, 2017
- Accepted May 11, 2017
- Published online August 7, 2017.
- Michael J. Blaha, MD, MPHa,∗ (, )
- Martin Bødtker Mortensen, MD, PhDa,b,
- Sina Kianoush, MD, MPHa,
- Rajesh Tota-Maharaj, MDa,c and
- Miguel Cainzos-Achirica, MD, MPHa,d,e
- aJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
- bDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- cFlorida Heart and Vascular Multi-Specialty Group, Leesburg, Florida
- dIDIBELL–Bellvitge Biomedical Research Institute, Barcelona, Spain
- eRTI Health Solutions, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Michael J. Blaha, Department of Cardiology, The Johns Hopkins Hospital, Blalock 524D1, 600 North Wolfe Street, Baltimore, Maryland 21287.
Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution). After discussing the potential implementation of an improved score in clinical practice, we follow with a discussion of the future of CAC scoring, asking the central question: do we really need a new CAC score?
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 11, 2017.
- Revision received May 6, 2017.
- Accepted May 11, 2017.
- 2017 American College of Cardiology Foundation
- Central Illustration
- Traditional CAC Scoring Methods
- Strengths and Weaknesses of Traditional CAC Scoring Methods
- Fundamental Framework for Building a New CAC Score
- Potential Strategies for Improving CAC Scoring
- Potential Strategies for Improving CAC Scan Acquisition
- Incorporating Extracoronary Calcification
- Changes in CAC Scoring: Target Population, Risk Prediction, and the Path Forward
- Challenges and Future Directions
- Summary and Conclusions