Coronary Calcium Score (Koronarkalk-Score)

Non-contrast cardiac CT to quantify coronary artery calcification using the Agatston score on a 640-slice Canon Aquilion ONE GENESIS scanner. Rapid, no contrast dye, no referral required. GOÄ self-pay estimate ~€180. Used to stratify cardiovascular risk before deciding on statin or preventive therapy.

The coronary artery calcium (CAC) score at Osypka Herzzentrum München quantifies calcified atherosclerotic plaque in the coronary arteries using a short non-contrast cardiac CT on the 640-slice Canon Aquilion ONE GENESIS scanner. The Agatston method produces a standardised numerical result reported per coronary artery territory — left main, left anterior descending, left circumflex, and right coronary artery — and as a total score. A score of zero indicates no detectable coronary calcification and is associated with very low 10-year risk of cardiovascular events, providing objective reassurance for patients and supporting conservative management decisions. Scores between 1 and 99 indicate mild calcification, 100–399 moderate disease, and scores above 400 indicate extensive coronary calcification with substantially elevated risk. The 640-slice architecture of the Canon Aquilion ONE GENESIS scanner offers particular advantages for calcium scoring compared with standard 64-slice platforms. The full cardiac volume is covered in a single rotation during one heartbeat, removing the temporal uncertainty inherent to multi-beat step-and-shoot acquisitions at conventional scanners. This improves calcium detection consistency across all coronary territories and reduces partial-volume averaging at small calcific foci — preventing under-counting of calcium at the leaflets of coronary plaques. ECG gating synchronises acquisition to the diastolic phase of the cardiac cycle to minimise cardiac motion. Radiation exposure for the non-contrast CAC scan is very low — typically below 1–2 mSv, comparable to the natural background radiation received over a few months in Germany. No iodinated contrast agent is required, eliminating contrast allergy and nephrotoxicity risk, and making the examination suitable for patients with impaired renal function who could not safely receive contrast for full coronary CT angiography. Examination duration is under 15 minutes including preparation. The CAC score is most clinically valuable in patients at intermediate cardiovascular risk — individuals in whom standard tools based on age, blood pressure, cholesterol, and smoking status predict a 5–15% ten-year risk of cardiovascular events, where the result will genuinely alter management. In this population, a zero CAC score provides grounds for deferring statin therapy, while elevated scores strengthen the case for intensifying preventive treatment. This indication is explicitly supported in European Society of Cardiology and German cardiology society guidelines. The OHZ cardiac team interprets results in the context of the full clinical picture, and patients with elevated scores can be directly referred for full coronary CT angiography or further evaluation within the same centre. The examination requires pre-scan ECG to confirm adequate rate control for gating. Preparation consists of avoiding caffeine on the examination day and arriving with a clean ECG lead placement site. The OHZ secretary team handles appointment scheduling from Monday to Friday; pre-scan laboratory values for thyroid and kidney function are requested where contrast is being considered as a follow-on step.