Coronary artery calcium is a significant marker for predicting cardiovascular incidents. It shows that atherosclerosis, which is the buildup of plaques in the arteries, might have been developing for a while. Not having coronary calcifications generally suggests there isn't advanced atherosclerosis present. Nonetheless, the role of coronary artery calcium in individuals experiencing stable chest pain, a recurrent condition triggered by stress, exercise, or cold weather, remains uncertain. Coronary artery calcium scoring via CT scan is a method for assessing calcium levels in the heart's arteries non-invasively. High scores correlate with the presence of atherosclerosis. For example, a score between 1 to 399 indicates a moderate level of plaque, whereas a score of 400 or above points to a significant accumulation of plaque. Now, a new study has found that coronary artery calcium scoring through CT scans can identify patients with stable chest pain who are at a very low risk of experiencing heart attacks or strokes. This discovery could potentially allow some patients to avoid undergoing invasive coronary angiography in the future.

In the study, researchers at Charité – Universitätsmedizin Berlin (Berlin, Germany) analyzed the prognostic significance of coronary artery calcium scores in predicting major adverse cardiovascular events in 1,749 participants, averaging 60 years old, from the DISCHARGE trial which spanned 26 centers across 16 European countries. These participants, who suffered from stable chest pain, were initially referred for invasive coronary angiography—a process where a catheter is navigated to the heart under X-ray observation, followed by the injection of a contrast medium to visualize the heart's arteries. The study categorized the participants into low-, intermediate-, and high-risk groups based on their coronary artery calcium scores and monitored them for an average of 3.5 years to track major cardiovascular events.

The study results showed that participants with a coronary artery calcium score of zero were at exceptionally low risk for major cardiovascular events, with only four out of 755, or 0.5%, experiencing such events during the follow-up. This group also had a low 4.1% risk of developing obstructive coronary artery disease. There were 14 events among 743 participants with scores ranging from 1 to 399, marking a 1.9% risk, and the 251 participants with scores of 400 and above had 17 events, indicating a significantly higher risk of 6.8%. The study did not find any gender differences in the risk of major adverse cardiovascular events. However, the researchers indicated that more research is necessary before coronary artery calcium scoring can definitively rule out the need for coronary CT angiography in patients. 

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