Incidental Coronary Artery and Cardiac Calcification on CT Scans
Over 950,000 thoracic CT scans are performed annually in the UK which is likely to increase further as targeted lung health checks are expanded. Incidental coronary and cardiac calcification are frequent findings on such non-gated thoracic CT.
However, whilst Coronary Artery calcification is a biomarker for the burden of atherosclerosis and thereis strong evidence that increasing levels of CAC are associated with an increasing level of obstructive coronary artery disease and worse prognosis, it is NOT on its own a method to identify flow limiting Coronary Artery stenoses.
If Coronary Artery calcification is detected, it will now be classified on the CT report as mild, moderate or severe, and should prompt primary care clinicians to assess/ risk stratify and further investigate/refer as below/ flow chart.
For asymptomatic patients, there is no current evidence to support further imaging (ischaemia testing, CT coronary angiography or invasive coronary angiography). However there is someevidence that preventative measures (that is risk modification and the use of statins) improve prognosis. Assess patient preferences and comorbidities.
For symptomatic patients, who have cardiac sounding chest pain as per NICE CG 95 consider, in addition to addressing modifiable risk factors, referral for further investigation via Rapid Access Chest Pain Clinic / Cardiology.
This is local guidance based on National consensus advice from the British Society of Cardiac Imaging and British Society of Cardiac CT.
Rapid Access Chest Pain Clinic referral guidelines available here
Consensus Statement ,British Society Cardiovascular imaging, BJR Vol 94, Oct 2020 https://www.birpublications.org/doi/10.1259/bjr.20200894
Cardiovascular disease: risk assessment and reduction, NICE CG181, Updated Sept 2016
Recent onset chest pain, NICE CG 95, updated Nov 2016
Dr Bridgitte Wesson, GP & Kernow RSM Cardiology Guideline lead
Dr Tom Sulkin, Consultant Radiologist, RCHT