In patients with chest pain, CCTA identifies increased risk for all-cause death. Importantly, a negative CCTA portends an extremely low risk for death.

This large observational data series shows that CAC provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.

This large observational data series shows that coronary calcium provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.

Background-There is a clear relationship between absolute calcium scores (CS) and severity of coronary artery disease.However, hard coronary events have been shown to occur across all ranges of CS. Methods and Results-We conducted 2 analyses: in group A, 172 patients underwent electron-beam CT (EBCT) imaging within 60 days of suffering an unheralded myocardial infarction. In group B, 632 patients screened by EBCT were followed up for a mean of 32Ϯ7 months for the development of acute myocardial infarction or cardiac death. The mean patient age and prevalence of coronary calcification were similar in the 2 groups (53Ϯ8 versus 52Ϯ9 years and 96% each). In group B, the annualized event rate was 0.11% for subjects with CS of 0, 2.1% for CS 1 to 99, 4.1% for CS 100 to 400, and 4.8% for CS Ͼ400, and only 7% of the patients had CS Ͼ400. However, mild, moderate, and extensive absolute CSs were distributed similarly between patients with events in both groups (34%, 35%, and 27%, respectively, in group A and 44%, 30%, and 22% in group B). In contrast, the majority of events in both groups occurred in patients with CS Ͼ75th percentile (70% in each group). Conclusions-Coronary calcium is present in most patients who suffer acute coronary events. Although the event rate is greater for patients with high absolute CSs, few patients have this degree of calcification on a screening EBCT. Conversely, the majority of events occur in individuals with high CS percentiles. Hence, CS percentiles constitute a more effective screening method to stratify individuals at risk. (Circulation. 2000;101:850-855.)

The volumetric score showed better reproducibility than the traditional score, and its variability was considerably less than the score increase in untreated patients after 1 year. The reproducibility of the volumetric method makes it useful for assessing the progression of coronary arterial disease on serial electron-beam CT studies.