Coronary Artery Calcification

Coronary artery calcification is a buildup of calcium that can predict your cardiovascular risk. Symptoms like chest pain usually don’t happen until you’ve had it for a while. Your healthcare provider has several options to remove the calcifications narrowing your coronary artery. Success rates are high, but there are risks with each treatment.


Calcium buildup causing coronary artery calcification.
Calcium collecting in coronary arteries.

What is coronary artery calcification?

Coronary artery calcification is a collection of calcium in your heart’s two main arteries, also called your coronary arteries. This happens after you've had plaque (fat and cholesterol) forming in your arteries (atherosclerosis) for about five years.

Coronary artery calcification is an indicator of coronary artery disease and can give your healthcare provider information to help them assess your cardiovascular risk.

When plaque accumulates in your arteries, it makes it harder for blood to get through. Good blood flow is crucial in your coronary arteries because they supply oxygen-rich blood to your heart muscle. If blood can’t get through your coronary arteries, it can lead to chest pain and/or a heart attack.

Two types of coronary artery calcification

  • Intimal (in the intimal or inner artery layer). This type is more common in coronary arteries.
  • Medial (in the medial or middle artery layer).


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Coronary artery calcification vs. atherosclerosis

The amount of calcification you have is an indicator of how bad your atherosclerosis may be. Atherosclerosis is the result of plaque collecting in your arteries, making them narrow. This makes it difficult for blood to get through your arteries.

Who does coronary artery calcification affect?

People who have coronary heart disease usually have coronary artery calcification.

In people older than 70, more than 90% of men and 67% of women have coronary artery calcification. Before menopause, estrogen protects women from developing atherosclerosis. This is why women tend to develop atherosclerosis 10 to 15 years later than men.

People who are white are more likely than other races to have coronary artery calcification.

You’re more likely to get coronary artery calcification if you have:

People who were assigned male at birth also have a higher risk for coronary artery calcification.


How does coronary artery calcification affect my body?

Coronary artery calcification makes your arteries stiff and less able to expand and contract. This puts you at a higher risk for cardiovascular issues.

Coronary artery calcification causes less blood to get to your heart muscle.

Calcification makes it difficult for your healthcare provider to do percutaneous coronary intervention (PCI) or angioplasty. It makes it harder to expand a stent to keep your artery open.

Symptoms and Causes

What are the symptoms?

People with coronary artery calcification often don’t have any symptoms. Over time, people may get symptoms, such as:


What causes coronary artery calcification?

After age 40, calcium from your bloodstream can settle in parts of your body. Damaged, inflamed or repaired arteries are more likely to attract calcium deposits. This process can start in your 20s, but your healthcare provider may not see it until there’s an amount large enough to show up on imaging. And most people in their 20s and 30s wouldn’t have a reason to get imaging.

Calcium deposits start small (.5μm or micron/micrometer) and grow to be larger than 3mm with plaque continuing to accumulate at the same time.

Researchers believe that microcalcification in the intimal layer starts when smooth muscle cells die.

Diagnosis and Tests

What tests will be done to diagnose coronary artery calcification?

A type of imaging called computed tomography or multidetector computed tomography (MDCT) can find coronary atherosclerosis before it becomes advanced.

A cardiac CT (computed tomography) scan can show calcified plaque deposits in your coronary arteries. This is called a coronary artery calcium (CAC) test, which looks at:

  • How many deposits you have.
  • How dense the deposits are.
  • How large they are.

Your healthcare provider will multiply your calcification area by its density to get an Agatston score. You get a score of 0 to 400 or more, with higher scores indicating a larger risk of a heart attack or stroke in 10 years.

Providers have found the CAC test accurately predicts future cardiovascular risk.

You may have to pay for this test out of your own pocket.

Coronary artery calcification scores

  • A score of 0 shows no disease.
  • From 1 to 99 indicates mild disease.
  • From 100 to 399 shows moderate disease.
  • More than 400 shows severe disease.

More invasive methods to check your coronary artery calcification include:

  • Cardiac intravascular ultrasound (IVUS) gives you a result from Class I to Class IV, with the fourth class describing the most severe calcification. For IVUS, your healthcare provider uses an ultrasound wand at the end of a catheter (tube) to see the inside of your coronary arteries.
  • Intravascular optical coherence tomography (IVOCT) can show you how much calcification you have and how thick it is. It uses near-infrared light to create images from inside your coronary artery. A probe on a catheter sends out the light and detects it.

Management and Treatment

How is coronary artery calcification treated?

Although healthcare providers don’t have a standard treatment for coronary artery calcification, some are using intravascular lithotripsy to treat severe cases. This newer procedure uses a catheter (tube) with a device at the end that sends pressure waves out to make the calcification come apart. After the procedure, your provider can put in a stent (small metal tube) to keep your artery open.

Other treatments to improve artery blood flow:

  • Rotational, orbital or laser atherectomy to cut plaque and calcium out of your artery.
  • Cutting, scoring or high-pressure balloon angioplasty to push plaque with calcium against your artery walls.

Complications of the treatment

  • Intravascular lithotripsy complications may include:
  • Arrhythmia (abnormal heart rhythm).
  • Aneurysm, or a blood vessel that’s stretched out.
  • Bleeding complications.
  • Stroke.
  • Death.

Rotational atherectomy complications may include:

Coronary angioplasty complications may include:

  • Heart attack.
  • Stroke.
  • Arrhythmia (abnormal heart rhythm).
  • Bleeding.
  • Blood clots.


How can I reduce my risk?

You can reduce your risk of coronary artery calcification by treating the problems that put you at risk for it. These include:

  • Diabetes mellitus.
  • Abnormal cholesterol levels.
  • High blood pressure.
  • Kidney disease.

Outlook / Prognosis

What can I expect if I have coronary artery calcification?

If you have coronary artery calcification, you’re at a high risk of developing coronary artery disease and major adverse cardiovascular events (MACE).

Outlook for coronary artery calcification

Intravascular lithotripsy was successful in more than 92% of cases, and rotational atherectomy has had a 90% success rate.

Coronary artery calcification increases the chances that a balloon angioplasty will fail. It also makes it more difficult to put a stent in a position where it would work best.

Living With

How do I take care of myself?

If you have coronary artery calcification, you should follow the recommendations for a heart-healthy lifestyle, including:

  • Eating foods low in fat.
  • Avoiding tobacco products.
  • Exercising regularly.
  • Keeping your blood pressure and cholesterol at a normal level.

When should I see my healthcare provider?

If you have high blood pressure and/or high cholesterol, you should see your healthcare provider regularly to make sure you’re controlling those issues. See your healthcare provider if you need a plan for how to improve your cardiovascular health.

When should I go to the ER?

Call 911 if you’re having chest pain, nausea and vomiting, shortness of breath or other signs of a heart attack.

What questions should I ask my doctor?

  • Do I need to have my coronary artery calcification checked?
  • How severe is my coronary artery calcification?
  • What treatment do you recommend for my specific situation?

A note from Cleveland Clinic

Knowing if you have coronary artery calcification can help your healthcare provider make a plan for how to help you. You may need a procedure to clear calcium deposits out of your coronary arteries or you just may need to pick up heart-healthy habits. Even if you don’t have cardiovascular issues, you can eat less fat, exercise more and avoid tobacco products to help keep yourself healthy.

Medically Reviewed

Last reviewed on 05/09/2022.

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