Coronary Calcium Scoring (CCS)

Coronary Calcium Scoring (CCS)

Coronary Calcium Scoring (CCS), also known as Coronary Artery Calcium (CAC) scoring, is a non-invasive imaging test that quantifies the amount of calcified plaque in the coronary arteries. This test is performed using computed tomography (CT) and serves as an important tool for assessing the risk of coronary artery disease (CAD) and predicting future cardiac events.

Purpose and Importance

1. Assessment of Atherosclerosis: CCS helps detect the presence of coronary artery calcification, which is a key indicator of atherosclerosis—the buildup of plaque in the arteries that can lead to heart attacks and other cardiovascular diseases.
2. Risk Stratification: The calcium score provides more predictive power than traditional risk factors such as cholesterol levels, smoking history, and hypertension in determining an individual’s risk for developing symptomatic coronary disease.
3. Guiding Treatment Decisions: Knowing a patient’s calcium score can help healthcare providers make informed decisions regarding lifestyle modifications, preventive therapies, and further diagnostic testing.

How the Test Works

• Procedure: The CCS test involves a CT scan that takes only a few minutes. Patients are positioned on a table, and EKG leads may be placed on their chest to monitor heart activity during the scan. The procedure does not require intravenous contrast or extensive preparation.
• Scoring System: The results are reported as an Agatston score, which quantifies the extent of calcification:
• Score 0: No detectable coronary calcification; low risk of heart disease.
• Score 1-100: Minimal to mild plaque burden; low risk but may require lifestyle changes.
• Score 101-400: Moderate plaque burden; increased risk of heart disease; medication may be recommended.
• Score >400: Extensive calcification; high risk for significant coronary artery disease; further evaluation and treatment are typically necessary.

Indications for CCS

CCS is particularly recommended for:

• Individuals aged over 40 (men) or over 50 (women) with risk factors such as:
• Family history of heart disease
• High cholesterol
• Diabetes
• Hypertension
• Smoking
• Obesity
• Patients with borderline indications for preventive therapy who are uncertain about starting treatment.

Benefits and Risks

• Benefits:
• Non-invasive and quick procedure with minimal radiation exposure (approximately 1 mSv).
• Provides valuable information that can influence management strategies for cardiovascular health.
• Risks:
• While the radiation dose is low, there is still a small risk associated with exposure to X-rays.
• Misinterpretation of results can lead to unnecessary anxiety or overtreatment.

Conclusion

Coronary Calcium Scoring (CCS) is a valuable diagnostic tool that helps assess the risk of coronary artery disease by measuring calcified plaque in the coronary arteries. It aids in risk stratification and informs treatment decisions, making it an essential component of cardiovascular health assessment.

References

1. Insight Medical Imaging. (2024). Coronary Calcium Score. Retrieved from Insight Medical Imaging
2. PubMed Central. (2022). The Diagnostic and Prognostic Value of Coronary Calcium Scoring in … Retrieved from PMC
3. Bangkok Heart Hospital. (n.d.). Coronary Artery Calcium Scan (CAC). Retrieved from Bangkok Heart Hospital
4. RadiologyInfo.org. (n.d.). Cardiac CT for Calcium Scoring. Retrieved from RadiologyInfo
5. Healio Cardiology. (2024). Coronary Artery Calcium (CAC) Score Topic Review | Learn the Heart. Retrieved from Healio