Cardiac CT — Coronary Artery Calcium Score

Non-contrast ECG-gated cardiac CT to quantify coronary calcium burden using the Agatston scoring method. Stratifies 10-year cardiovascular risk. No contrast required. Estimated price: €140–180.

Coronary artery calcium (CAC) scoring is a non-contrast, ECG-gated CT scan that directly measures the amount of calcified atherosclerotic plaque in the coronary arteries. The Agatston score — the internationally standardised output — assigns a numerical value to the total calcium burden: a score of zero indicates no detectable coronary calcification and a very low 10-year risk of major cardiovascular events, while scores above 400 indicate extensive plaque and substantially elevated risk, often prompting more intensive preventive management regardless of the patient's traditional risk factor profile. The test takes five to ten minutes in the scanner and requires no intravenous contrast injection, making it safe for patients with renal impairment, contrast allergy, or those who want a definitive, low-risk cardiac screening test. ECG gating synchronises CT acquisition with the cardiac cycle to freeze the motion of the coronary arteries, which otherwise move continuously with each heartbeat. The radiation dose of a CAC scan is among the lowest in cardiac imaging, typically 1–1.5 mSv. Rehabilitační klinika Malvazinky's KardioPrevent programme already screens for cardiovascular risk using a clinical, echocardiographic, and laboratory battery. The CAC score extends this preventive framework by providing direct anatomical evidence of whether atherosclerotic disease is actually present, rather than merely estimating its probability from population statistics. For patients in intermediate cardiovascular risk categories — where traditional calculators based on age, blood pressure, cholesterol, and smoking leave genuine clinical uncertainty about initiating statin therapy — a measured calcium score reclassifies risk with high precision. The strongest evidence supporting CAC screening comes from the Multi-Ethnic Study of Atherosclerosis (MESA), which followed over 6,500 asymptomatic adults and demonstrated that a CAC score of zero was associated with an annualised cardiovascular event rate of below 1% across all ethnicities and risk groups. European Society of Cardiology preventive guidelines (2021) support CAC scoring as an option to reclassify intermediate-risk patients and guide treatment decisions. Cardiac CT is arranged for Malvazinky patients through the Group Mediterra network. The clinic's cardiology department (MUDr. David Šolc) provides pre-test consultation and integration of the CAC result with the patient's clinical risk assessment. Patients need no special preparation for the non-contrast study, though avoiding caffeine for four hours before scanning and having a resting heart rate below 65 bpm improves image quality. For patients whose heart rate is elevated, temporary beta-blockade may be recommended prior to the examination. Czech private-market pricing for CAC scores typically falls between 3,500 and 4,500 CZK (€140–180), making Prague one of the most cost-effective locations in Europe for cardiac calcium screening. The KardioPrevent programme at Malvazinky (9,000 CZK) can be combined with a separate CAC scan for a comprehensive two-modality cardiac risk assessment at a combined cost significantly below what equivalent assessments cost in Western Europe.