The Coronary Calcium Score for Risk Prediction

Sudden cardiac death belongs to the acute coronary syndromes, beside unstable angina and myocardial infarction. Today, 60%–80% of deaths due to myocardial infarction still occur outside the hospital. In order to detect individuals prone to such events, risk scores have been developed, including the Heart Score of the European Society of Cardiology. Drawbacks of all current risk scores are, however, the exclusion of signs of atherosclerosis, the underlying aetiology of plaque rupture and erosion leading to sudden death. Computed tomography is an ideal imaging tool, which is able to detect, to localise and to quantify calcified and noncalcified plaques in coronary vessels. The amount of calcium is related to coronary and cardiovascular risk, as well as all-cause mortality. The use of calcium-score risk prediction can eliminate a big problem of the current risk factors, because the lifetime exposure to risk factors, including genetic and heritable features, has an important influence on atherosclerosis. Individual, meaning personalised, management is provided. Plaque burden indicates the degree of risk, which is what matters most.