Coronary calcium is detectable opportunistically on thoracic CT: pooled analyses show 52% prevalence, and AI models can automate scoring and predict cardiovascular death risk
This review synthesizes evidence on opportunistically identifying and quantifying coronary artery calcium (CAC) on thoracic CT performed for other clinical indications (routine thoracic CT, lung cancer screening CT, attenuation correction CT), reporting a pooled CAC prevalence of 52%, independent associations with all-cause mortality (pooled relative risk 2.13) and major adverse cardiovascular events (pooled relative risk 2.61), and reviewing novel applications including AI/machine learning automated scoring, radiomics, photon-counting CT, and CAC as a multi-system biomarker, while noting that no randomized trials assessing the clinical impact of this approach have yet been published.