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Coronary Artery Calcium Score — EECC MCQ

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ModerateCardiac ImagingCoronary Artery Calcium ScoreEECC

A 55-year-old asymptomatic man with a family history of premature CAD (father died at age 50 from MI) undergoes a coronary artery calcium (CAC) score. The result is 450 Agatston units. What does this indicate and how should it influence management?

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Correct answer: A — Significant coronary atherosclerosis; reclassifies his risk upward and supports intensification of preventive therapy including high-intensity statin

A coronary artery calcium (CAC) score of 450 Agatston units places this patient above the 75th percentile for his age and sex, indicating significant coronary atherosclerosis. CAC scoring is recommended as a risk modifier in asymptomatic individuals at intermediate cardiovascular risk (ESC Prevention Guidelines), and a high CAC score reclassifies risk upward, supporting initiation or intensification of preventive therapy (high-intensity statin, BP control, lifestyle modification). CAC >400 is associated with a substantially elevated 10-year CV event rate. However, CAC does not assess luminal stenosis, and a high score alone does not mandate invasive angiography — functional testing or CTCA should follow only if ischaemic symptoms develop. CAC is a risk modifier, not a direct input into SCORE2.

Reference: ESC (2021): Guidelines on Cardiovascular Disease Prevention