Coronary calcium score interpretation
Enter the Agatston score from the non-contrast cardiac CT. The page places it in the conventional band, quotes what the 2018 AHA/ACC cholesterol guideline says about that stratum when the statin decision is uncertain, and drafts the sentence for the report. The age-sex-race percentile is not computed here — the MESA reference tool is linked, and the reasons are explained.
Score bands
| Agatston score | Descriptor |
|---|---|
| 0 | No identifiable coronary artery calcification |
| 1-10 | Minimal coronary artery calcification |
| 11-100 | Mild coronary artery calcification |
| 101-400 | Moderate coronary artery calcification |
| > 400 | Severe coronary artery calcification |
2018 AHA/ACC cholesterol guideline
Grundy SM, et al. Circulation 2019;139:e1082-e1143 (PubMed). Calcium scoring is used in adults 40-75 years at intermediate 10-year ASCVD risk (7.5% to < 20%), and in selected borderline-risk adults (5% to < 7.5%) with risk enhancers, when the decision to start a statin is uncertain. The strata and the guideline's wording:
| Stratum | Guideline statement |
|---|---|
| CAC 0 | It is reasonable to withhold statin therapy and reassess in 5 to 10 years, as long as higher-risk conditions are absent (diabetes mellitus, family history of premature CHD, cigarette smoking). |
| CAC 1-99 | It is reasonable to initiate statin therapy for patients ≥ 55 years of age; favours statin therapy in general, with the decision informed by the clinician-patient risk discussion. |
| CAC ≥ 100 or ≥ 75th percentile | It is reasonable to initiate statin therapy. |
Age-sex percentile and risk estimation
We do not reimplement the age-sex-race percentile here, and that is deliberate. The MESA percentile is a coefficient-table model: sex-, ethnicity- and age-stratified regression coefficients fitted to the MESA cohort, and a transcription slip anywhere in that table produces a percentile that looks authoritative and is wrong — and the 75th percentile is a statin threshold in the 2018 guideline. The official implementation is maintained and validated by the group that built the model. Use it, then bring the percentile back to the guideline strata here.
- MESA CAC reference values (age, sex, race/ethnicity percentile) — Enter age, sex, race/ethnicity and the Agatston score; returns the percentile within the MESA reference population.
- MESA 10-year CHD risk with CAC — Risk factors plus the calcium score; the CAC-inclusive estimate reclassifies a substantial share of intermediate-risk adults.
- ACC ASCVD Risk Estimator Plus — The pooled cohort equations the 2018 guideline starts from; the 10-year risk decides whether CAC is called for at all.
Related
- CAD-RADS 2.0 calculator — the calcium score sets the P1-P4 plaque burden modifier on coronary CTA
- All radiology calculators
MyRadAgent drafts the full report - and applies this guideline automatically, with the category and follow-up in the impression. Free trial runs in the browser: 100 reports over 14 days, no card, no IT ticket.
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