Key result
CAC scoring maintains robust prognostic value and consistent risk reclassification beyond contemporary clinical calculators.
Why the study?
Recent advances in AI, spectral CT, standardized reporting, and new evidence from 2018-2026 prompted an updated review of strengths, limitations, and practical guidance for coronary artery calcium scoring.
This review highlights the continued prognostic value of CAC scoring, emphasizing the 'power of zero', the very-high-risk phenotype of CAC ≥1,000, and new evidence that CAC-guided treatment reduces plaque progression.
Coronary artery calcium (CAC) scoring on non-contrast ECG-gated CT remains a robust, reproducible marker of total coronary atherosclerotic burden with clear prognostic value and consistent risk reclassification beyond contemporary clinical calculators. Recent studies (2018-2026) reinforce the 'power of zero' for near-term risk de-escalation, identify very high CAC (≥1,000) as a distinct, very-high-risk phenotype, and, importantly, provide randomized evidence that CAC-guided treatment reduces plaque progression. Advances in artificial intelligence (AI), spectral CT, and standardized reporting (SCCT/STR; CAC-DRS) expand opportunities for automated and incidental CAC detection. This mini-review summarizes updated strengths, limitations, and practice guidance; synthesizes new evidence (2024-2026); and includes a practical clinical decision flowchart for the selective use of CAC in prevention pathways.
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Sabouret et al. (2026) conducted a review in Coronary atherosclerotic burden and cardiovascular risk. Coronary artery calcium (CAC) scoring was evaluated. Coronary artery calcium scoring remains a robust marker of coronary atherosclerotic burden with clear prognostic value and consistent risk reclassification beyond contemporary clinical calculators.
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