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CAC Score Risk Reclassification — EECC MCQ

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ModerateCoronary Artery DiseaseCAC Score Risk ReclassificationEECC

A 45-year-old man with no cardiac history undergoes a coronary artery calcium (CAC) score as part of a health screening. His CAC score is 350 Agatston units. He has no symptoms. What is the clinical significance and recommended action?

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Correct answer: D — A CAC score of 100-399 indicates moderate coronary atherosclerosis; it significantly reclassifies cardiovascular risk upward and supports initiation of statin therapy and intensified risk factor management, even in otherwise low-risk individuals

CAC scoring provides direct imaging evidence of coronary atherosclerotic plaque burden. Risk categories: 0 = very low risk; 1-99 = mild; 100-399 = moderate; ≥400 = extensive. CAC is a powerful risk reclassifier: a score of 350 in a 45-year-old (above the 90th percentile for age/sex) significantly increases the estimated 10-year ASCVD risk, often from intermediate to high-risk category. The ESC/EAS Dyslipidaemia Guidelines and 2021 Prevention Guidelines include CAC as a risk modifier that can guide statin initiation in patients at borderline/intermediate risk. A CAC >100 generally supports statin therapy. CAC scoring does NOT require contrast and involves very low radiation (~1 mSv). It does NOT detect non-calcified (soft) plaque and should NOT be used in symptomatic patients (where CTCA or functional testing is more appropriate).

Reference: ESC (2021): CVD Prevention; ESC/EAS Dyslipidaemia Guidelines