Calcium score vs CT Coronary Angiography: Which test is suitable for your heart?

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Calcium scoring and CT coronary angiography are both non-invasive medical imaging tests used to assess coronary artery health, but they serve different purposes and provide distinct information.

Calcium Scoring (Coronary Artery Calcium Scoring):

  1. Purpose: Detects and quantifies coronary artery calcification, which is a marker of atherosclerosis (plaque buildup).
  2. Test: Non-contrast CT scan of the heart.
  3. Measures: Calcium deposits in the coronary arteries, expressed as an Agatston score (0-400+).
  4. Interpretation:
    • 0: No detectable calcium (low risk).
    • 1-100: Mild calcification (moderate risk).
    • 101-400: Moderate calcification (higher risk).
    • > 400: Severe calcification (high risk).
  5. Advantages: Quick, low radiation, and low cost.
  6. Limitations: Can not detect soft plaques which are more prone to dislodge and can cause blockage at distal arteries, especially in young people. If calcium score is more than 400, then further CT coronary angiography can not be performed due to overestimation of blockage.

CT Coronary Angiography (CTCA):

  1. Purpose: Evaluates the coronary arteries for stenosis (narrowing), plaque, and blockages.
  2. Test: Contrast-enhanced CT scan of the heart, which is done ECG gated.
  3. Measures: Coronary artery diameter, stenosis, and plaque characteristics.
  4. Interpretation:
    • Identifies location, severity, and characteristics of coronary artery disease.
    • Guides treatment decisions (e.g., angioplasty, stenting, or bypass surgery).
  5. Advantages: High sensitivity and specificity for detecting significant coronary artery disease. It can also detect soft plaques which are more prevalent in young people.
  6. Limitations: Only a diagnostic procedure and not a therapeutic one.

To know more about CT coronary angiography, please click here.

Key differences:

  1. Contrast: CTCA requires contrast agent, while calcium scoring does not.
  2. Purpose: Calcium scoring assesses risk especially in older people, while CTCA evaluates coronary artery disease severity.
  3. Detail: CTCA provides more detailed information about coronary artery anatomy and plaque characteristics.
  4. Cost: Calcium scoring is generally less expensive than CTCA.
  5. Radiation: CTCA typically has higher radiation exposure than calcium scoring. But the radiation exposure is justified against the details available regarding coronary artery status.

When to use each test:

  1. Calcium scoring:
    • Asymptomatic old individuals with risk factors for coronary artery disease.
    • Assessing cardiovascular risk.
    • Monitoring progression of coronary artery disease.
  2. CTCA:
    • Asymptomatic young individuals with risk for coronary artery disease or family history of coronary artery disease
    • Symptomatic patients with suspected coronary artery disease.
    • Evaluating chest pain or shortness of breath.
    • Guiding treatment decisions for coronary artery disease.

In summary, calcium scoring is a screening test for coronary artery disease risk in older individuals, while CTCA is a diagnostic test for evaluating coronary artery disease severity and guiding treatment. Your doctor will decide which test is best for you based on your individual needs and medical history.

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