CT-Cal score emerges as a popular, non-invasive tool to detect heart attacks

Even as the Union Health Ministry recently submitted to Parliament that cases of heart attack are not notifiable, and there is no central registry for these adverse health events, doctors and medical institutes note that there is a significant rise in the number of people seeking preventive check-ups for cardiac care.

The coronary artery calcium (CT-Cal) score has emerged as a powerful, non-invasive tool for investigating heart health. Obtained from a heart CT scan, it quantifies the calcified plaque burden in coronary arteries, which directly reflects atherosclerotic disease. Calcified plaque is a build-up of fats, cholesterol, and other substances in and on the walls of arteries, which could lead to the obstruction of blood flow, and the occlusion of arteries by clots, among other issues. 

Doctors note that predicting adverse cardiac events requires a mix of clinical judgment and the right tests. 

“A higher calcium score correlates with increased risk of myocardial infarction (commonly known as heart attack) and cardiac mortality, while a score of zero is highly reassuring in ruling out significant coronary artery disease in asymptomatic individuals,’’ Dr. Vishal Rastogi, director, Cardiology, Fortis Hospital, Okhla, Delhi, said. The strength of the test lies in reclassifying intermediate risk patients, and guiding preventive therapy, particularly in the prescription of statins (a class of medicines), he added.

“However, it should not replace clinical assessment or functional testing in symptomatic patients. Thus, CT-Cal score is most useful as a prognostic test in primary prevention, helping doctors and patients understand risk, and make proactive lifestyle and treatment choices,’’ Dr. Rastogi said.

Traditional risk stratification begins with routine tools, including lipid profile, blood sugar, ECG (electrocardiogram), echocardiography, and treadmill testing. For higher precision, advanced modalities, including coronary CT (computed tomography) angiography, and cardiac MRI (magnetic resonance imaging) can refine risk prediction. 

“Several tests are available to assess cardiovascular risk and predict future heart problems,” Dr. Sanjeeva Kumar Gupta, consultant, Department of Cardiology at the C.K. Birla Hospital, Delhi, said.

The market for investigation offers standard evaluations, including testing blood pressure, lipid profiles, and HbA1c (glycated haemoglobin); performing ECGs, echocardiography, and exercise stress tests, Dr. Gupta added. 

High-sensitivity C-reactive protein (hs-CRP) can also show vascular inflammation, which contributes to risk assessment, he said. 

Among imaging tools, the CT-Cal score is especially useful. “A heart CT calcium scoring provides detailed structural information of the heart and can help detect coronary artery disease, sometimes even before symptoms arise. It measures calcified plaque in the coronary arteries, giving a clear indication of subclinical atherosclerosis. However, this non-invasive test has limitations. It has no role in assessing atheromatous plaque build-up or total plaque burden, nor does it evaluate heart function. Therefore, while the CT calcium score is valuable, particularly in refining risk assessment for people with intermediate profiles or inconclusive standard test results, it should always be interpreted alongside clinical factors and other diagnostic evaluations,’’ Dr. Gupta said.

“Prevention is the best cure,” Dr. Rajiv Bhal, head of the Indian Council of Medical Research, said, speaking on what ensures good heart health.

“Vital healthy habits include preventing childhood obesity; staying away from smoking, alcohol (binge drinking); drug abuse; and unmanaged stress,’’ Dr. Bhal said.

Genetic testing could also indicate if an individual is prone to adverse cardiac health, he added. 

While there is a rise in the number of people coming in for testing heart health, “Consistent tests guided by doctors are recommended for individuals in the high-risk category. Obsessive self-testing is not encouraged in the general population,” Dr. H.N. Ravikumar, chief of lab operations, Metropolis Healthcare Limited, Karnataka, said.

Published – August 21, 2025 02:28 am IST