Measurement and Application of Incidentally Detected Coronary Calcium: JACC Review Topic of the Week.

Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease risk stratification. The nongated, noncontrast chest computed tomography scan (NCCT) has emerged as a source of CAC characterization with tremendous potential due to the high volume of NCCT scans. Application of incidental CAC characterization from NCCT has raised questions around score accuracy, standardization of methodology including the possibility of deep learning to automate the process, and the risk stratification potential of an NCCT-derived score. In this review, the authors aim to summarize the role of NCCT-derived CAC in preventive cardiovascular health today as well as explore future avenues for eventual clinical applicability in specific patient populations and broader health systems. [Display omitted] • CAC detected incidentally on NCCT scans is strongly correlated with gated CT Agatston scores and cardiovascular disease outcomes. • Challenges include standardizing quantification of CAC detected by NCCT, validating its prospective power, and avoiding unnecessary downstream testing based solely on the findings. • Interdisciplinary collaboration and integration into health care delivery could improve atherosclerotic risk stratification. [ABSTRACT FROM AUTHOR]