CT coronary angiography and coronary calcium score
Two tests, often confused
- Two distinct tests, often confused:
| Coronary artery calcium score (CACS) | CT coronary angiography (CTCA) | |
|---|---|---|
| Contrast | No | Yes (iodinated) |
| Radiation | ~1 mSv | ~1-5 mSv (modern, prospective gating) |
| Measures | Calcified plaque burden only | Lumen + wall: calcified AND non-calcified plaque, stenosis severity |
| Use | Risk reclassification in the asymptomatic | Diagnosis in the symptomatic |
| Blind to | Non-calcified (soft) plaque - can be 0 in a young ACS patient | - |
- CTCA is an anatomical test, not a functional one - it shows stenosis, not ischaemia
- A 60% stenosis on CTCA may or may not be flow-limiting - hence CT-FFR and downstream physiology
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