CT coronary angiography and coronary calcium score
Who should have a CTCA or a calcium score, how to read CAD-RADS 2.0 and Agatston categories, what a score of zero does and doesn't mean, and the Medicare rules that apply in Australia.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- CTCA is ECG-gated, contrast-enhanced CT of the coronary arteries. It shows stenosis and plaque, calcified or not. It is the preferred first test for symptomatic patients at low to moderate clinical likelihood of obstructive disease (ESC 2024).
- Coronary artery calcium (CAC) score is a non-contrast gated CT that counts calcified plaque in Agatston units. It is mainly a primary prevention tool. In symptomatic patients ESC 2024 uses it only to adjust the clinical likelihood (the CAC-weighted model), and CAC 0 doesn't exclude obstructive non-calcified plaque.
- A normal CTCA has a negative predictive value around 97 to 99%.
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Sources
- Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-537European Society of Cardiology, 2024
- Jennings GLR, Audehm R, Bishop W et al. National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia. Med J Aust 2021;214(9):434-9AU/NZNational Heart Foundation of Australia, 2021
- 2023 Australian guideline for assessing and managing cardiovascular disease risk. Med J Aust 2024;220(9):482-90AU/NZAustralian Chronic Disease Prevention Alliance, 2023
- MSAC application 1815: computed tomography of the coronary arteries to determine coronary artery calcium scoreAU/NZMedical Services Advisory Committee, 2026 (under assessment)
- MBS item 57360: CT coronary angiographyAU/NZAustralian Government Department of Health, Disability and Ageing (MBS Online), descriptor 1 Nov 2021, explanatory note IN.2.2 (accessed 13 Nov 2026)
- Cury RC, Leipsic J, Abbara S et al. CAD-RADS 2.0: 2022 coronary artery disease reporting and data system. J Cardiovasc Comput Tomogr 2022;16:536-57SCCT, ACR, NASCI, 2022
- SCOT-HEART Investigators. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med 2018;379:924-33New England Journal of Medicine, 2018
- DISCHARGE Trial Group. CT or invasive coronary angiography in stable chest pain. N Engl J Med 2022;386:1591-602New England Journal of Medicine, 2022
- Last updated
- 14 November 2026
What changed
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