Estimation of cardiac event risk by MDCT.

Coronary calcifications are specific markers for coronary atherosclerosis. The amount of coronary calcium is related to the likelihood of vulnerable plaques. Vulnerable plaques may rupture and may result in sudden coronary thrombus formation, occlusion, ischemia and ventricular fibrillation and finally cardiac death. Therefore, it is reasonable to believe that the risk of cardiac events can be assessed by the quantification of the extent of coronary calcium. However, until now, the predictive value of coronary calcium and the advantage over conventional risk factors has not yet been proven by any prospective cohort study. In practice uncertainty exists in the group of patients with an intermediate risk for cardiac events. In this particular cohort it is likely that the assessment of coronary atherosclerosis may help in the decision to initiate or discard a specific therapy. For this purpose it has been suggested to replace the Framingham age score by a score corrected by the amount of coronary calcium. Follow-up investigations may be helpful in the short term to determine the efficiency of different therapeutical options. To determine a significant progression of the amount of coronary calcium, the absolute mass should be determined in a period of 1 year.