Patient guide · 5-minute read
CT coronary calcium scoring, the low-dose CT that quantifies coronary calcium and reclassifies risk.
CT coronary calcium scoring is a fast, low-dose CT that quantifies calcified plaque in the coronary arteries. The Agatston score powerfully reclassifies intermediate-risk patients and guides statin decisions.
Reviewed by Pulse Atlas Editorial Board, · Published 2026-07-30 · Next review 2027-07-30
Key facts
What CT coronary calcium scoring is, at a glance.
Six facts to anchor the rest of the page — the definition, radiation dose, who benefits most, the Agatston thresholds, and where the score sits alongside QRISK3.
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Definition
Low-dose non-contrast CT of the heart with automated Agatston scoring.
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Radiation
Very low dose — approximately 1 mSv per study.
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Contrast
No IV contrast required.
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Who benefits most
Reclassifies intermediate-risk patients (QRISK3 10–20%).
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Thresholds
Score 0 = very low CV risk; > 100 = statin consideration; > 400 = high risk.
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Where it fits
Complementary to lipid panel and QRISK3 in shared statin decisions.
Preparation & procedure
What actually happens, in order.
CT coronary calcium scoring is short, painless and needs no fasting or contrast. Here is the seven-step sequence from consultation to structured cardiology plan.
- 01
Consultation and referral
Cardiovascular history, risk factors and prior imaging are reviewed with a clinician before booking.
- 02
No fasting required
Eat, drink and take medication as normal on the day of the scan.
- 03
No IV contrast
No cannula, no dye and no iodinated contrast — nothing is injected.
- 04
ECG-gated non-contrast CT
A prospectively gated low-dose acquisition of the heart lasting only seconds on the scanner.
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Automated Agatston calculation
Dedicated software segments calcified plaque and computes the total and per-vessel Agatston score.
- 06
Radiologist reporting
A consultant radiologist reviews the images, verifies the score and places it in the MESA age/sex percentile.
- 07
Cardiology follow-up plan
A written report and structured cardiology plan for statin, lifestyle and any onward imaging.
What it shows
What CT coronary calcium scoring can visualise.
Agatston score, MESA percentile, the four risk bands and extensive coronary calcification — plus the red-flag pattern that warrants same-day cardiology and CTCA.
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Agatston score (total and per vessel)
The headline number and its distribution across LAD, LCx, RCA and left main.
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MESA percentile
Your score placed in age- and sex-matched percentiles from the MESA reference cohort.
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Very low risk (score 0)
No detectable coronary calcification — a strong negative predictor over the next decade.
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Mild risk (1–99)
Early calcified plaque — lifestyle emphasis and shared decision on statin therapy.
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Moderate risk (100–399)
Established coronary calcification — statin therapy usually indicated.
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High risk (≥ 400)
Extensive calcified plaque — high 10-year event risk; intensive prevention.
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Extensive coronary calcification
Diffuse multi-vessel disease pattern that reframes long-term prevention strategy.
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Red flag: score > 400 in symptomatic patient — urgent cardiology + CTCA
A high score with chest pain is a same-day cardiology and CT coronary angiography pathway.
Treatment & next steps
What the score may lead to.
Reassurance, statin decisions, additional imaging and structured cardiology follow-up — always decided by a cardiologist, not the score alone.
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Reassurance for score 0
A score of zero carries a very low 10-year event risk and often defers statin initiation.
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Lifestyle advice
Diet, exercise, weight, smoking cessation and sleep — the foundation whatever the score.
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Statin therapy per score and risk
Score-guided initiation and intensity, integrated with QRISK3 and lipid profile.
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Additional CTCA if symptomatic
CT coronary angiography to characterise stenosis when symptoms accompany a high score.
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Cardiovascular risk optimisation
Blood pressure, diabetes, LDL and lifestyle targets tightened in parallel.
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Cardiac rehabilitation
Structured exercise and secondary-prevention programme where indicated.
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Repeat scoring at 5–10 years
Serial CAC to track progression where clinically useful — not routinely annual.
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Structured cardiology follow-up
A named cardiologist owning the ongoing prevention plan.
Red flags
When findings need urgent escalation.
Any of the following should be routed to a same-day cardiology pathway rather than a routine outpatient follow-up.
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Score > 400 with symptoms
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Family history of premature CAD
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Familial hypercholesterolaemia
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Bilateral carotid stenosis with high CAC
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Type 1 diabetes with high CAC
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Rapid progression on serial CAC
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Chronic inflammatory disease
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Prior chest radiation
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Cocaine use with CAC
Frequently asked
Common questions about CT coronary calcium scoring.
How the scan works, what the Agatston thresholds mean, radiation dose, who benefits most and how often to repeat it.
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What is CT coronary calcium scoring?
A fast, low-dose, non-contrast CT of the heart that quantifies calcified atherosclerotic plaque in the coronary arteries. Dedicated software converts the calcium burden into an Agatston score, which is placed in age- and sex-matched MESA percentiles to refine cardiovascular risk.
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How is it different from a coronary calcium score?
They describe the same underlying test. This page frames it explicitly as the CT-based scoring protocol — the low-dose, ECG-gated non-contrast CT acquisition and the Agatston calculation — for people searching for that specific technique. See our companion page at /tests/coronary-calcium-score for a broader overview.
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What does the Agatston score mean?
A score of 0 indicates no detectable coronary calcification and a very low 10-year event risk. Scores of 1–99 suggest mild disease, 100–399 moderate disease and ≥ 400 extensive disease with high event risk. Interpretation is always integrated with age, sex, lipids and QRISK3.
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Does the scan involve contrast or radiation?
No IV contrast is used. Radiation dose is very low — approximately 1 mSv, comparable to a few months of natural background radiation and well below a diagnostic CT of the chest.
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Who benefits most from CT coronary calcium scoring?
Intermediate-risk adults — typically QRISK3 10–20% — where the score can meaningfully reclassify risk up or down and sharpen the shared decision about starting a statin.
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How often should the scan be repeated?
A score of 0 is often reassuring for 5–10 years in appropriate patients. Repeat imaging is guided by cardiology, symptoms and risk trajectory rather than by a fixed annual interval.
Sources
The guidelines that shape this page.
Reviewed by Pulse Atlas Editorial Board, . Last updated 2026-07-30; next review 2027-07-30.
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In practice, in London
What CT coronary calcium scoring looks like on the ground in London
With CT coronary calcium scoring, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Public provision for CT coronary calcium scoring is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics — Marylebone, the City, Chelsea, Canary Wharf — means most patients can find something that fits around work without a cross-town trek. For CT coronary calcium scoring specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for CT coronary calcium scoring isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.