How do you decide between ordering coronary calcium scoring versus coronary CTA in asymptomatic patients with low to moderate risk for CAD?

Arteries try to “heal” atherosclerotic plaques by calcifying them. Consequently, the presence of coronary artery calcium (CAC) indicates that there is at least some coronary atherosclerotic plaque. The amount of coronary calcium is quantified using the “Agatston” CAC score. The higher the score, the...

The only useful reason to order a coronary calcium score I have found is to help decide on or convince a patient to start statin therapy for primary prevention. CTA with FFR is an ischemic evaluation tool and should be used in the proper setting, best with stable patients with low regular heart rate...

In patients at low risk of CAD who are asymptomatic, a coronary artery calcium score or coronary CTA is not generally useful. In patients who are at moderate risk of coronary artery disease who are not symptomatic, I would get a coronary artery calcium score to further refine their risk. If they hav...

Often, CT coronary calcium scoring is most useful in turning the tide with regard to the need for lipid-lowering therapy. Often, it is useful to convince patients to accept statin therapy. Conversely, a CT coronary calcium score of zero with a non-ischemic ETT is very useful to reassure patients.

CT Coronary calcium score would be the preferred imaging tool to further refine a patients estimated ASCVD risk to inform decision to prescribe a statin, for example. I do not think there is a role for coronary CTA in most asymptomatic patients. Exceptions would be as part of an ischemic work-up in ...

"Statin Paradox"

Patients on long-term statin therapy have increased coronary calcification yet have significantly reduced major adverse cardiovascular events. As mentioned previously by Dr. @Dr. First Last, coronary calcification is a byproduct of inflammation and then subsequent healing of the ath...