Purpose of Technology: Coronary artery calcium (CAC) scoring uses computed tomography scanning to detect and assess the extent of atherosclerosis and quantifies the findings using a scoring system to assess and stratify risk of coronary artery disease in asymptomatic adults.

Rationale: A large proportion of people are categorized in the “intermediate risk” category of global assessment instruments, for which treatment guidance is less clear than for low-risk or high-risk categories. Further, these instruments are not perfect. CAC, used in conjunction with global assessments, is intended to improve the accuracy of risk assessment and to reduce the number of patients classified as intermediate risk.

Controversy: CAC has been proposed as a minimally invasive method to more accurately predict risk of coronary artery disease (CAD), but at the expense of radiation exposure and additional cost.

Relevant Questions: Relevant questions regarding the use of CAC scoring in adults with no signs or symptoms of CAD include:

  • What is the incremental predictive value and risk level reclassification of CAC scoring when added to traditional office-based global risk assessment (e.g., the Framingham Risk Score)? 

  • Does CAC scoring lead to improvement in clinical outcomes? 

  • What harms are associated with CAC scoring? 

  • Have definitive patient selection criteria for CAC scoring been established?

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