Extending the Use of Coronary Calcium Scanning to Clinical Rather Than Just Screening Populations

Twenty-five years after its initial development, coronary artery calcium (CAC) scanning has become a relatively inexpensive test that has been extensively validated as a potent noninvasive means for assessing the burden of coronary atherosclerosis in asymptomatic individuals. A proportional relationship between the magnitude of CAC abnormality and the frequency of subsequent cardiac events over longterm follow-up has been consistently demonstrated, including observations from large patient and population-based cohorts. Incremental prognostic value over standard clinical assessments including the Framingham Risk Score and other scores of global risk has also been consistently reported. Consequently, the application of CAC scanning for assessing asymptomatic patients with intermediate clinical risk has now become part of clinical guidelines.