Evaluating the Implications of a Coronary Artery Calcium Score of Zero (CAC = 0) in Modern Risk Prediction: Is Zero Truly Zero?

Coronary artery calcium (CAC) scoring is a well-validated screening tool used to calculate the amount of calcified plaque deposited in coronary arteries from a computed tomography (CT) scan. It stratifies patients by risk to predict their future probability of cardiovascular disease and helps establish the ideal preventive therapies. Considering these factors, the purpose of this narrative review is to evaluate the latest research on the effectiveness of CAC scoring, explore the various limitations and challenges faced in utilizing this tool, and discuss alternative investigations commonly used to supplement it for risk stratification.