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Cardiac Health Assessment
Comparing Coronary Artery Calcium Scoring and Coronary Angiography for Assessing Cardiac Health
This is a detailed subject, and what it means for your situation depends on your history and your imaging. Dr. Glowney is glad to work through it with you.
What each test measures.
Assessing cardiac health helps predict cardiovascular events and guide prevention. Two common tests are coronary artery calcium (CAC) scoring and coronary angiography, and each shows something different about coronary artery disease (Hamilton-Craig et al., 2017; Groves et al., 2016).
Coronary artery calcium scoring uses computed tomography to detect and measure calcified plaque in the coronary arteries (Hamilton-Craig et al., 2017). The resulting CAC score reflects the total burden of calcified atherosclerosis, aiding in risk stratification for future cardiovascular events (Navarrete-Hurtado & Carvajal-Rivera, 2019). A higher CAC score goes with a higher risk of heart attacks and other cardiac events (Detrano et al., 2008). This non-invasive test is particularly useful for people without symptoms who are at intermediate risk, as it can refine risk assessment and inform decisions about preventive treatment such as statins (Navarrete-Hurtado & Carvajal-Rivera, 2019). A CAC score of zero means a very low risk of cardiovascular events in people without symptoms, and some of them may be able to put off cholesterol medication or daily aspirin (Qazi et al., 2016).
In contrast, Coronary Angiography involves injecting contrast dye into the coronary arteries, typically via cardiac catheterization, followed by X-ray imaging to visualize the arterial lumen. It shows the inside of the arteries filled with contrast and is used to judge how severe a narrowing is (Mintz et al., 2022). It is considered the gold standard for diagnosing coronary artery disease and guides decisions about opening blocked arteries (Groves et al., 2016). Coronary angiography is also the standard way to guide stent placement during angioplasty (Tonino et al., 2009).
Choosing between the two.
Which test fits depends on whether a person has symptoms (Hamilton-Craig et al., 2017; Bertolone et al., 2022). For people without symptoms who are at intermediate risk, CAC scoring is a useful screening test to measure calcified plaque and refine risk estimates (Hecht, 2015; Qazi et al., 2016). When symptoms or other tests point to significant coronary artery disease, invasive angiography is recommended when non-invasive imaging is inconclusive and the likelihood of disease is very high (Bertolone et al., 2022).
While both CAC scoring and coronary angiography play important roles in assessing cardiac health, the decision to use one or the other depends on the clinical scenario. Used together, these tests give a fuller picture of coronary artery disease and help guide care.
References
Sources cited.
- Bertolone, D. T., Gallinoro, E., Esposito, G., Paolisso, P., Bermpeis, K., De Colle, C., Fabbricatore, D., Mileva, N., Valeriano, C., Munhoz, D., Belmonte, M., Vanderheyden, M., Bartunek, J., Sonck, J., Wyffels, E., Collet, C., Mancusi, C., Morisco, C., De Luca, N., ... Barbato, E. (2022). Contemporary management of stable coronary artery disease. High Blood Pressure & Cardiovascular Prevention, 29(3), 207–219. https://doi.org/10.1007/s40292-021-00497-z
- Detrano, R., Guerci, A. D., Carr, J. J., Bild, D. E., Burke, G., Folsom, A. R., Liu, K., Shea, S., Szklo, M., Bluemke, D. A., O'Leary, D. H., Tracy, R., Watson, K., Wong, N. D., & Kronmal, R. A. (2008). Coronary calcium as a predictor of coronary events in four racial or ethnic groups. The New England Journal of Medicine, 358(13), 1336–1345. https://doi.org/10.1056/NEJMoa072100
- Groves, E. M., Seto, A. H., & Kern, M. J. (2016). Invasive testing for coronary artery disease: FFR, IVUS, OCT, NIRS. Heart Failure Clinics, 12(1), 83–95. https://doi.org/10.1016/j.hfc.2015.08.007
- Hamilton-Craig, C. R., Chow, C. K., Younger, J. F., Jelinek, V. M., Chan, J., & Liew, G. Y. (2017). Cardiac Society of Australia and New Zealand position statement executive summary: Coronary artery calcium scoring. The Medical Journal of Australia, 207(8), 357–361. https://doi.org/10.5694/mja16.01134
- Hecht, H. S. (2015). Coronary artery calcium scanning: Past, present, and future. JACC: Cardiovascular Imaging, 8(5), 579–596. https://doi.org/10.1016/j.jcmg.2015.02.006
- Mintz, G. S., Matsumura, M., Ali, Z., & Maehara, A. (2022). Clinical utility of intravascular imaging: Past, present, and future. JACC: Cardiovascular Imaging, 15(10), 1799–1820. https://doi.org/10.1016/j.jcmg.2022.04.026
- Navarrete-Hurtado, S., & Carvajal-Rivera, J.-J. (2019). Tomografía axial computarizada coronaria en la estratificación de riesgo. Revista Colombiana de Cardiología, 26, 134–141. https://doi.org/10.1016/j.rccar.2019.04.007
- Qazi, A. H., Zallaghi, F., Torres-Acosta, N., Thompson, R. C., & O'Keefe, J. H. (2016). Computed tomography for coronary artery calcification scoring: Mammogram for the heart. Progress in Cardiovascular Diseases, 58(5), 529–536. https://doi.org/10.1016/j.pcad.2016.01.007
- Tonino, P. A., De Bruyne, B., Pijls, N. H., Siebert, U., Ikeno, F., van' t Veer, M., Klauss, V., Manoharan, G., Engstrøm, T., Oldroyd, K. G., Ver Lee, P. N., MacCarthy, P. A., Fearon, W. F., & FAME Study Investigators. (2009). Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. The New England Journal of Medicine, 360(3), 213–224. https://doi.org/10.1056/NEJMoa0807611
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