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June 3, 20260 citationsOpen Access

Utility of the Agatston Score in Detecting Obstructive Coronary Artery Disease: A Case Report on the Limitations of Lipid-Based Risk Stratification

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DMDr. N. MurugesanDADr. Mark Christopher ArokiarajVMVenkatram Murugesan

Key Result

Coronary Artery Calcium (CAC) scoring identified high-grade stenosis requiring stenting in a 72-year-old male with normal lipid parameters, underscoring its utility as a diagnostic tool.

Key Points

  • This report assesses the effectiveness of the Agatston score in identifying obstructive coronary artery disease, particularly in patients with normal lipid levels.
  • Case report of a 72-year-old male with a history of myocardial infarction presenting with normal lipid parameters and a CAC score over 1000.
  • Diagnostic procedures included Coronary Angiogram (CAG) and stenting for identified high-grade stenosis.
  • Discovery of high-grade stenosis despite normal lipid levels highlights limitations of traditional lipid-based risk assessment.
  • Successful intervention via CAG and stenting underscores the importance of non-invasive calcium scoring.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 72-year-old male with a history of myocardial infarction and normal lipid parameters who presented with a Coronary Artery Calcium score exceeding 1000.
E
Exposure
Coronary Artery Calcium (CAC) scoring followed by Coronary Angiogram (CAG) and stenting
O
Outcome
Detection of high-grade stenosis

CAC scoring can identify critical obstructive coronary artery disease in high-risk patients who have normal lipid parameters.

Abstract

Abstract: - Traditional cardiovascular risk assessment often relies heavily on lipid panels and symptomatic presentation. However, a significant cohort of patients remains at risk despite maintaining "normal" cholesterol levels. This case report discusses a 72-year-old male with a history of myocardial infarction (2019) who presented with a paradoxical profile: stable, normal lipid parameters but a critical Coronary Artery Calcium (CAC) score exceeding 1000. The subsequent discovery of high-grade stenosis and successful intervention via Coronary Angiogram (CAG) and stenting underscores the necessity of non-invasive calcium scoring. This report argues for the broader integration of CAC scoring as a regular diagnostic tool, not only for the elderly but as a proactive screening measure for younger adults to intercept early-stage atherosclerosis.

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Cite This Study

Murugesan et al. (2026) conducted a case report in Obstructive Coronary Artery Disease (n=1). Coronary Artery Calcium (CAC) scoring was evaluated on Detection of high-grade stenosis. Coronary Artery Calcium (CAC) scoring identified high-grade stenosis requiring stenting in a 72-year-old male with normal lipid parameters, underscoring its utility as a diagnostic tool.

synapsesocial.com/papers/6a1fc58bdee9eb8c0dce6fe9https://doi.org/10.5281/zenodo.20486297
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1C-44 | Identifying the Coronary Artery Calcium Score Threshold Indicative of Obstructive Coronary Artery Disease2024
  2. 2Point of Care Clinical Risk Score to Improve the Negative Diagnostic Utility of an Agatston Score of Zero2019 · 9 citations
  3. 3Utilizing the coronary artery calcium score to predict coronary artery disease in individuals with presumed cardiac symptoms: A diagnostic study2026
  4. 4Role of Coronary Artery Calcium Score CT in Risk Stratification of Asymptomatic Individuals2025
  5. 5Utility of coronary artery calcium scoring in low-risk patients: The Multi-Ethnic Study of Atherosclerosis (MESA)2025 · 7 citations