Using the calcium score alone:
A calcium score 1000 and higher:
In this study, having a calcium score 1000 or higher is associated with a 25% chance of having a major heart event in 1 year (1). By major heart event, we mean heart attack or sudden cardiac death.
That’s higher than someone who needs a stent or bypass (7.4%).
Write this down: 1 year risk = 25%. You are in the highest risk group. According to another study (2) your 10 year risk is 65%. Write that down too.
Sometimes too much information isn’t helpful. If you are feeling overwhelmed, you can skip this page and go right to the next step: To use your percentile score to get a 10 year risk estimate, click on the NEXT button below.
This study compared those with a calcium score of over 1000 to a control group of patients who had severe obstructive blockage in the heart arteries (bad enough to need a stent or bypass surgery). (1) Obstructive blockage is considered to be the worst type blockage (see the far right section of the artery. The small red arrow represents the blood flow, which is blocked or obstructed. When the blood flow is obstructed, we put in stents or a bypass to open up the flow of blood.) Compare that small red arrow to the larger red arrow in the vulnerable plaque area, where there is plenty of blood flow, but a high risk of ruptured plaque. When plaque ruptures, the laceration on the inside of the artery exposes the blood to the soft cholesterol junk in the plaque, setting off a blood clot, or a thrombus, which causes heart attacks and most strokes.
You would think most heart attacks occur in the most severe obstructive blockage, but they do not. Most heart attacks (80%) occur in vulnerable plaque where the blood flow is fine moments before the rupture and thrombus occurs. (3)
Why? Because in the arteries, vulnerable lesions are a lot more common than obstructive lesions.
Calcium means inflammation. Lots of inflammation means the arteries are hot and sick.
So then, it is not surprising that people with calcium scores over 1000 had a 1 year risk 3 times higher compared to those with 1 or 2 obstructive plaques needing stents or bypass surgery.
Remember than any 10 year risk over 20% is considered high risk. Having a 1 year risk of 25% is considered extremely high risk.
And you must also remember this: your risk is not the end of the story. You have the power to dramatically reduce your risk.
We specialize in high risk patients.
To quote from this study of 98 patients, “The annualized event rate in subjects with a CS (calcium score) ≥ 1,000 was significantly greater than that of historical controls with severe perfusion abnormalities (ie, obstructive blockage) on MPI (25% vs. 7.4%, respectively; p < 0.0001).” Small studies can show significant findings if they measure clinically important phenomena. Wayhs, et al. High coronary artery calcium scores pose an extremely elevated risk for hard events. J Am Coll Cardiol. 2002 Jan 16;39(2):225-30
This study associated percentile score with risk. Patients with a calcium score 1000 or higher are in the top tenth percentile group. Raggi, et al. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 2001;141:375-82.
Little WC, Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation. 1988;78:1157-1166