CT coronary angio
The following question has been sent by Akhilesh Singh:
CT coronary angio – what is the normal range of calcium score?
Ralf Bauer, MD, Clinic of the Goethe University, Frankfurt, Germany:
Dear Mr. Singh, thank you for your question!
But actually, it is not easy to answer. First, there is no real “normal” range. The clinical value of the Agatston score depends on a) the patients´s cardiovascular risk profile and b) if the patient is symptomatic or not.
The amount of coronary calcium needs to be seen in context of the patient´s sex and age, and what is “normal” varies with these parameters. There are age- and sex-adapted tables. A CS of >75.
percentile is considered abnormal. There is the old, traditional classification with 4 steps: Agatston Score of 0, 1-100, 101-400 and >400. Significant coronary artery stenosis is considered to be very unlikely with a CS of 0, where a score of >400 is considered to represent a very high likelihood for significant coronary artery stenosis.
In asympotmatic patients it has been understood that an elevated CS represents an independent risk factor in addition to classic cardiovascular risk factors with incremental prognostic value.
In symptomatic patients, various different managment strategies have been proposed for patients with elevated CS up till now reaching from a combination of CS + invasive cath angio to CS + myocardial perfusion imaging. However, there have also been a couple of studies that showed no relation of elevated CS and the degree of coronary stenosis or the presence of a perfusion defect. This pretty much depends on the level of athereosclerotic risk of the investigated study population.
Most of all, it needs to be understood, that a negative calcium scoring scan does not exclude soft plaques and severe stenosis caused by them.
This is one of the reasons why in our institution we do not perform a stand-alone calcium scoring scan, but always do a coronary CTA, too.
I recommend a recently published excellent review article on coronary calcium scoring by Nucifora G et al in Cardiovascular Therapeutics 2010, doi: 10.1111/j.1755-5922.2010.00172.x
Best regards
Ralf Bauer
