Coronary calcium score as a marker for risk stratification of ischemic heart disease

Abstract

This literature review focuses on the role of the coronary calcium score (CCS) as a marker for risk stratification of ischemic heart disease (IHD). CCS, assessed via computed tomography (CT) using the Agatston score, outperforms traditional risk scales (Framingham, SCORE) in detecting subclinical atherosclerosis, particularly in patients with intermediate risk. Studies, including MESA and PROMISE, demonstrate that a CCS >100 is associated with a 7-fold increased risk of cardiovascular events, while a CCS = 0 indicates a low risk (<0.1% annual risk). Modern low-dose protocols (<0.3 mSv) and dual-energy CT enhance diagnostic safety and accuracy. CT angiography identifies non-calcified plaques linked to acute coronary syndromes. Integrating CCS with biomarkers (interleukins) and genetic data (9p21, SORT1 loci) improves risk prediction. The literature search was conducted in PubMed, Scopus, and eLibrary databases using the keywords “coronary artery calcium,” “ischemic heart disease,” and “CT angiography” for the period 2008–2024. Articles in English and Russian, including meta-analyses and clinical studies, were included.