Calcium scoring misses soft plaque in younger patients and can be dangerously reassuring. A 55-year-old with zero calcium score had a severe widow-maker lesion visible only on cardiac CTA, which shows both calcified and soft plaque and measures stenosis.
Let's talk about calcium scores, cardiac CT angiograms, my favorite thing to talk about. Gonna talk fast to get in 90 seconds. So calcium scores should be reserved— I don't care what any guideline says, I'm sorry— they should be reserved for people over the age of 50. Why? Because calcium takes time to form. If you are a 30-year-old and you get a calcium score and it is zero, we expect it to be zero. The calcium has not had time to form. You could have a cholesterol-rich soft, super yucky, super vulnerable plaque that has not had time to calcify yet. So if you get a calcium score and you're young, okay, it can make you think that everything's okay when indeed everything could not be okay because it hasn't had time to form. So a lipid-rich, soft, yucky plaque might not— well, will not show up on a calcium score. So my rule of thumb in my office is no calcium scores under the age of 50.. And I love, love, love cardiac CT angiograms. You take the same test, you slow it down a little bit, you add IV contrast. Now you see everything— cholesterol plaque, soft plaque, where the plaque is, what percent blockage it is, everything that you really can't see on a calcium score. So I'm going to show you this patient right here, 50-something years old when he had his test, and I believe he was 55. His calcium score would have been zero, and yet he has a yucky, nasty, nasty widowmaker, and he was completely asymptomatic. Cardiac CTAs for the win.
