1 The power of zero
In asymptomatic individuals over 40, a CAC score of 0 is the strongest negative predictor for a future myocardial infarction — superior to a negative family history or normal lab biomarkers. A zero is associated with highly favorable long-term survival and an extremely low risk (< 1%) of major cardiovascular events over the next 5 to 10 years.
2 The important caveat
A score of zero does not completely rule out coronary artery disease. Patients can still harbor non-calcified, “soft” (vulnerable) plaques. This is particularly relevant in:
- Younger patients (< 40 yr) whose plaques have not yet calcified
- Patients actively experiencing acute chest pain symptoms — where soft, ulcerated plaque is the more likely culprit and a coronary CT angiogram (with contrast) is the right next test rather than relying on calcium alone