Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking

Purpose of Review: We review the potential role of coronary artery calcium (CAC) scoring in the initial evaluation and risk stratification of patients with low- to moderate-risk, stable and acute, chest pain. Recent Findings: A negative CAC score (CAC = 0) has a negative predictive value of 94–99% in symptomatic patients with a low to moderate pretest probability of coronary artery stenosis. The sensitivity is superior to that of stress testing, and the risks, costs, and need for expertise are less than that of coronary CT angiography. Additionally, patients with CAC = 0 have an extremely low risk of future adverse coronary events with an incidence of only 0.0–0.8%, whereas those with CAC > 0 have significantly higher event rates (2.5–18%). Summary: In low-risk chest pain patients, a negative CAC score can effectively “rule out” an ischemic etiology in patients experiencing chest pain. Higher CAC scores are associated with a proportionately increased risk of coronary artery stenosis and warrant further testing. CAC scoring can serve as an effective gatekeeper for further resource utilization given the high prevalence and excellent sensitivity of CAC = 0.