Coronary artery calcium scoring in 2026: strengths, limitations, and optimized clinical use.
| Title: | Coronary artery calcium scoring in 2026: strengths, limitations, and optimized clinical use. |
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| Authors: | Sabouret P; Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, Paris, France.; Giamundo DM; Department of Cardiology, Policlinico Casilino, Rome, Italy.; Rosencher J; Department of Cardiology, CMC Ambroise Paré, Neuilly-sur-Seine, France.; Figliozzi S; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy. |
| Source: | Frontiers in radiology [Front Radiol] 2026 Apr 13; Vol. 6, pp. 1822303. Date of Electronic Publication: 2026 Apr 13 (Print Publication: 2026). |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: Frontiers Media SA Country of Publication: Switzerland NLM ID: 9918367586306676 Publication Model: eCollection Cited Medium: Internet ISSN: 2673-8740 (Electronic) Linking ISSN: 26738740 NLM ISO Abbreviation: Front Radiol Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Lausanne, Switzerland] : Frontiers Media SA, [2021]- |
| Abstract: | Coronary artery calcium (CAC) scoring on non-contrast ECG-gated CT remains a robust, reproducible marker of total coronary atherosclerotic burden with clear prognostic value and consistent risk reclassification beyond contemporary clinical calculators. Recent studies (2018-2026) reinforce the 'power of zero' for near-term risk de-escalation, identify very high CAC (≥1,000) as a distinct, very-high-risk phenotype, and, importantly, provide randomized evidence that CAC-guided treatment reduces plaque progression. Advances in artificial intelligence (AI), spectral CT, and standardized reporting (SCCT/STR; CAC-DRS) expand opportunities for automated and incidental CAC detection. This mini-review summarizes updated strengths, limitations, and practice guidance; synthesizes new evidence (2024-2026); and includes a practical clinical decision flowchart for the selective use of CAC in prevention pathways.; (© 2026 Sabouret, Giamundo, Rosencher and Figliozzi.) |
| Competing Interests: | The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. |
| Contributed Indexing: | Keywords: atherosclerotic burden; cardiovascular risk stratification; coronary CT imaging; coronary artery calcium (CAC) score; primary prevention |
| Entry Date(s): | Date Created: 20260429 Date Completed: 20260429 Latest Revision: 20260429 |
| Update Code: | 20260429 |
| PubMed Central ID: | PMC13111553 |
| DOI: | 10.3389/fradi.2026.1822303 |
| PMID: | 42051876 |
| Database: | MEDLINE |
Journal Article; Review