Calcium Score, Non-Obstructive Coronary Artery Disease and Cardiovascular Events

Cardiovascular disease is the leading cause of morbidity and mortality in Brazil, except for 2021, when the COVID-19 pandemic caused the infectious disease to take that position. Cardiovascular risk stratification for atherosclerotic events aims to identify individuals at higher risk and, consequently, those with the greatest potential benefit from pharmacological therapy to reduce these events. However, risk prediction equations still lack sufficient calibration and discrimination for the Brazilian population. This opens a precedent for the incorporation of other laboratory or imaging biomarkers to complement and optimize the accuracy of cardiovascular risk stratification. The coronary calcium score (CCS) has been extensively analyzed in different populations, and its association with atherosclerotic coronary events is robust, culminating in its incorporation into Brazilian and American dyslipidemia guidelines.^.

However, it should be noted that the CCS only reflects the calcified part of the atheromatous plaque, not allowing for the assessment of the degree of luminal stenosis, the total composition of the plaque, or the total atherosclerotic burden. Nevertheless, there is a correlation between higher CCS and higher plaque burden.

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