Beyond coronary calcium: a new era in cardiovascular risk assessment

This editorial refers to ‘CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients’, by I. Danad et al., https://doi.org/10.1093/ehjci/jeaf093. The role of coronary computed tomography angiography (CCTA) has emerged over the past decade due to its ability to quantify and characterize coronary atherosclerosis, allowing accurate risk stratification in patients with suspected coronary artery disease (CAD). The use of CCTA is steadily increasing, particularly in patients at low-to-moderate risk of obstructive CAD. Coronary artery calcium (CAC) scoring, performed using ECG-gated non-contrast computed tomography, is a widely used and reliable surrogate marker for CAD. It is particularly valuable in individuals with a low likelihood of obstructive CAD, helping to reclassify them as very low risk. Importantly, a CAC score of zero has a negative predictive value of over 95% for obstructive CAD. In addition, even opportunistic reporting of CAC to clinicians has been shown to significantly increase statin prescription, as demonstrated in the NOTIFY-1 trial.1