Coronary Artery Calcium Scoring
Open accessAbstract
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?
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Research has demonstrated the importance of evolving the Agatston score in the era of evidence-based statin and aspirin prescription, non-statin lipid-lowering therapy and the shift towards personalised risk assessment.
“However, research has demonstrated the importance of evolving the Agatston score in the era of evidence-based statin and aspirin prescription, non-statin lipid-lowering therapy and the shift towards personalised risk assessment.54”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [54]
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Self-citation
- Authors
- Blaha, M. J., Mortensen, M. B., Kianoush, S., Tota-Maharaj, R., & Cainzos-Achirica, M.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Blaha, Michael J.
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 10
- Issue
- 8
- Pages
- 923-937
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2744127741
- Cited by
- 276
- References
- 59
- Citations by year
- 2026: 20 · 2025: 38 · 2024: 23 · 2023: 27 · 2022: 37 · 2021: 50 · 2020: 41 · 2019: 26 · 2018: 11 · 2017: 3
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Scopus (Elsevier) (submittedVersion)
- Funders
- American College of Cardiology Foundation
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- coronary artery calcium scoring, calcium density, cardiovascular risk prediction, coronary artery calcification, coronary artery disease
- MeSH terms
- Computed Tomography Angiography, Algorithms, Coronary Artery Disease, Coronary Vessels, Decision Support Techniques, Humans, Predictive Value of Tests, Prognosis, Severity of Illness Index, Reproducibility of Results, Coronary Angiography, Vascular Calcification, Multidetector Computed Tomography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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