Frontiers in Radiology · Published 2026-04-13 · DOI 10.3389/fradi.2026.1822303
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.
Abstract from DOAJ. Public domain (CC0 1.0).
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