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Questions and Answers
What is the primary purpose of Coronary Artery Calcium Scoring (CAC)?
What is the primary purpose of Coronary Artery Calcium Scoring (CAC)?
Which category on the calcium scale indicates a very low risk of death?
Which category on the calcium scale indicates a very low risk of death?
What factor could significantly limit the performance of a CAC procedure?
What factor could significantly limit the performance of a CAC procedure?
What does the total Agatston score represent?
What does the total Agatston score represent?
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At what calcium score range is an individual categorized as having a moderate risk of death?
At what calcium score range is an individual categorized as having a moderate risk of death?
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What is a common characteristic of individuals who have a CAC score greater than 400?
What is a common characteristic of individuals who have a CAC score greater than 400?
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What is the all-cause mortality rate for individuals with a CAC score between 1-100 after 15 years?
What is the all-cause mortality rate for individuals with a CAC score between 1-100 after 15 years?
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Which of the following factors is NOT part of the calcium score categories?
Which of the following factors is NOT part of the calcium score categories?
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What is the significance of a coronary artery calcium (CAC) score of 101-400?
What is the significance of a coronary artery calcium (CAC) score of 101-400?
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Which factor is NOT a limitation of the CAC procedure?
Which factor is NOT a limitation of the CAC procedure?
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What is the expected all-cause mortality rate for a patient with a CAC score of 400-999 after 15 years?
What is the expected all-cause mortality rate for a patient with a CAC score of 400-999 after 15 years?
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What does the Agatston score primarily assess in a CAC scan?
What does the Agatston score primarily assess in a CAC scan?
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Why is early treatment with statins often recommended in patients with a high CAC score?
Why is early treatment with statins often recommended in patients with a high CAC score?
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What is the CAC score category associated with a risk of death greater than 20% at 10 years?
What is the CAC score category associated with a risk of death greater than 20% at 10 years?
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What does the calcium scale indicate for a CAC score of 0?
What does the calcium scale indicate for a CAC score of 0?
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What is a key characteristic of the technique used for CAC scoring?
What is a key characteristic of the technique used for CAC scoring?
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Which calcium score range indicates a mild risk of coronary artery disease?
Which calcium score range indicates a mild risk of coronary artery disease?
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In the context of CAC scoring, what does a high calcium score generally signify?
In the context of CAC scoring, what does a high calcium score generally signify?
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Study Notes
Coronary Artery Calcium (CAC) Scoring
- CAC scoring is a non-invasive imaging technique that uses CT scans to measure calcium deposits in the coronary arteries.
- Calcium deposits signal the presence of atherosclerosis, a major risk factor for heart disease.
- CAC scoring is a tool for predicting future cardiac events in individuals who are asymptomatic.
- It is relevant for primary prevention, allowing early treatment decisions.
- The scan is fast (less than 10 seconds) and has a low radiation exposure.
- It does not require contrast agents.
Calcium Scoring Scale
- The scale has four categories with assigned risk levels:
- 0: No calcium. Very low risk of death (less than 1% within 10 years)
- 1-99: Mild calcium. Low risk of death (less than 10% within 10 years)
- 100-400: Moderate calcium. Intermediate risk of death (10-20% within 10 years)
- >400: Severe calcium. High risk of death (more than 20% within 10 years)
Total Agatston Score
- Represents the sum of all calcifications identified in the coronary arteries during the scan.
- While widely used and acknowledged, its accuracy and reproducibility are not always consistent.
Limitations of CAC Procedure
- Rapid or irregular heart rates (over 80 bpm) can affect scan quality.
- Very high scores (above 800-1000) may compromise the accuracy of the scan.
- Presence of stents in the arteries impacts imaging interpretation.
- Difficulty identifying calcium deposits in small vessels.
Coronary Artery Calcium (CAC) Scoring
- The Basics: CAC scoring uses an ECG-gated, non-contrast CT scan to measure calcium deposits in the coronary arteries.
- Purpose: It predicts the risk of future heart events in individuals without symptoms (primary prevention).
- Scan: Scan is quick (under 10 seconds), has low radiation exposure, and doesn't require contrast.
Calcium Scoring Categories
-
Scale: Categorizes scores into four groups:
- 0: None
- 1-99: Mild
- 100-400: Moderate
-
400: Severe
-
Risk Correlation:
- 0: Very low risk of death (<1% at 10 years)
- 1-100: Low risk of death (<10% at 10 years)
- 101-400: Intermediate risk of death (10-20% at 10 years)
-
400: High risk of death (>20% at 10 years)
Agatston Score
- What it is: Adds the calcium values across all coronary arteries in the scan.
- Widely Used but Not Always Accurate: Although widely used, accuracy and reproducibility may vary.
2010 ACCF/AHA Guidelines & Mortality Rates
- Framingham Risk Subsets: Guidelines link CAC scores and five-year mortality rates in Framingham risk subsets.
-
Tennessee Study: A 15-year study of 9,715 patients demonstrated the following all-cause mortality rates:
- CAC 0: 3%
- CAC 1-100: 6-9%
- CAC 101-399: 14%
- CAC 400-999: 21%
- CAC ≥ 1000: 28%
Limitations of CAC Procedure
- Rapid Heart Rate: Difficult to obtain accurate scores with heart rate over 80 bpm.
- High Calcium Scores: Accuracy may be limited with scores above 800-1000.
- Stents: Can interfere with score readings.
- Small Vessels: Difficult to accurately assess.
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Description
Explore the essential aspects of Coronary Artery Calcium (CAC) scoring, a vital tool for assessing atherosclerosis risk in asymptomatic individuals. This quiz covers the scoring scale, its importance in heart disease prevention, and the implications of calcium deposits in coronary arteries. Understand the classification of calcium levels and their associated risks.
