Coronary Artery Calcium, All-Cause Mortality, and Sudden Cardiac Death in Asymptomatic Populations

The prognostic value of coronary artery calcium (CAC) assessed by computed tomography (CT) for mortality risk has been discussed in the literature for over 3 decades.While this assessment has advanced through technological improvements and innovative methodologies, its fundamental evaluation framework has remained largely unchanged, and the original scoring system continues to underpin most CT-based calcium measurements.Accordingly, the purpose of the current review was to assess the existing knowledge regarding CAC evaluation and its relationship with all-cause mortality and sudden cardiac death.Overall, the data clearly demonstrate that CAC is a robust independent predictor of mortality.The evidence also suggests some degree of population heterogeneity, as well as a possible bimodal distribution in death prediction based on age.The data support the view that high CAC is strongly associated with an increased risk of all-cause mortality among asymptomatic younger (< 40 years) and older (> 70 years) adults.In contrast, evidence for mortality prediction based on sex remains inconclusive.The number of calcified blood vessels also influences mortality risk, with significantly higher risk in individuals with calcification of 3 or 4 vessels compared to those with 1.A high CAC score presents a substantially greater mortality risk, and scores > 1,000 appear to increase mortality by approximately 10-fold compared to a CAC score of 0. Furthermore, in asymptomatic individuals, CAC assessment has been shown to be a stronger predictor of mortality than traditional cardiovascular risk scoring.