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Review

Coronary artery calcium scoring: Its practicality and clinical utility in primary care

Parth Parikh, MD, Nishant Shah, MD, Haitham Ahmed, MD, MPH, Paul Schoenhagen, MD and Maan Fares, MD
Cleveland Clinic Journal of Medicine September 2018, 85 (9) 707-716; DOI: https://doi.org/10.3949/ccjm.85a.17097
Parth Parikh
Department of Internal Medicine, Cleveland Clinic
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Nishant Shah
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
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Haitham Ahmed
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Paul Schoenhagen
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Maan Fares
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  • For correspondence: [email protected]
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    Figure 1

    Pathogenic mechanism of atherosclerotic lesions and its relationship to the coronary artery calcium (CAC) score. A type 1 lesion (not depicted) contains lipoproteins that initiate an inflammatory response. A type 2 lesion contains an accumulation of foam cells. The type 3 lesion contains collections of extracellular lipid droplets. Eventually, these extracellular lipid pools form a lipid core, and a type 4 lesion is created. With time, this core develops a fibrous connective-tissue thickening that can calcify and give rise to a type 5 lesion detectable by imaging. Type 6 is a complicated lesion that can include thrombus from plaque rupture.

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    Figure 2

    A screenshot from a standard calcium scoring program. The images show a small calcified plaque in the mid-left anterior descending artery (left upper panel, colored yellow), left circumflex artery (right upper panel, colored blue), and right coronary artery (right lower panel, colored red). The table in the left lower panel lists the results of the calcium score. (The Agatston score is listed as “Score”). The graph in the right lower panel shows the results of the individual patient relative to an age-and sex-matched patient population (eg, the MESA trial). This patient has a score of 62.2, indicating relatively mild calcification and falling on the 75% percentile for age, sex, and ethnicity in a control group.

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    TABLE 1

    Categories of coronary artery calcium scores

    ScoreCategories
    0No atherosclerosis
    1–99Mild disease
    100–399Moderate disease
    > 400Severe disease
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Cleveland Clinic Journal of Medicine: 85 (9)
Cleveland Clinic Journal of Medicine
Vol. 85, Issue 9
1 Sep 2018
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Coronary artery calcium scoring: Its practicality and clinical utility in primary care
Parth Parikh, Nishant Shah, Haitham Ahmed, Paul Schoenhagen, Maan Fares
Cleveland Clinic Journal of Medicine Sep 2018, 85 (9) 707-716; DOI: 10.3949/ccjm.85a.17097

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Coronary artery calcium scoring: Its practicality and clinical utility in primary care
Parth Parikh, Nishant Shah, Haitham Ahmed, Paul Schoenhagen, Maan Fares
Cleveland Clinic Journal of Medicine Sep 2018, 85 (9) 707-716; DOI: 10.3949/ccjm.85a.17097
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  • Article
    • ABSTRACT
    • ATHEROSCLEROSIS AND CALCIUM
    • CALCIFICATION AND CORONARY ARTERY DISEASE
    • TECHNICAL INFORMATION ABOUT THE TEST
    • CALCIUM SCORING AS A DIAGNOSTIC TOOL
    • CALCIUM SCORING AS A PROGNOSTIC TOOL
    • COST-EFFECTIVENESS OF THE TEST
    • RISKS AND DOWNSIDES OF CALCIUM SCORING
    • WHO SHOULD BE TESTED?
    • OUR APPROACH
    • SUMMARY
    • REFERENCES
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