Cardiovascular Imaging

CAC Score vs. CCTA: Which Cardiovascular Scan Is Right for You?

Both coronary artery calcium (CAC) scoring and coronary CT angiography (CCTA) provide information about coronary artery disease — but they are different studies with different uses, risks, and requirements. Here's an honest comparison to help patients understand the distinction.

The Basic Difference

CAC scoring is a non-contrast CT scan that detects and quantifies calcified (hardened) plaque within the coronary artery walls. It produces a single number — the Agatston score — representing total coronary calcium burden.

CCTA (coronary CT angiography) uses IV contrast dye to directly visualize the coronary arteries. It can detect both calcified plaque (like CAC) and non-calcified (soft) plaque — which CAC cannot see. CCTA provides more anatomical detail but involves more complexity.

Side-by-Side Comparison

Feature	CAC Score	CCTA
Contrast required	No	Yes (IV iodine dye)
Kidney function (eGFR) needed	No	Yes
Heart rate preparation	Generally not required	Yes — target <60–65 bpm
Radiation dose	Low	Higher than CAC
Detects calcified plaque	Yes	Yes
Detects soft (non-calcified) plaque	No	Yes
Scan time	~10–15 minutes	~30–60 minutes (with prep)
Cost (self-pay, approximate)	Often $75–$200	Often $500–$1,500+
Typical use case	Intermediate risk assessment	Coronary anatomy evaluation
Provider order required	Yes (most facilities)	Yes

Prices are approximate and vary by facility and region. Diagnostic Orders Direct does not set or guarantee imaging facility pricing.

When CAC Is Typically Preferred

Intermediate cardiovascular risk (10-year ASCVD 7.5–20%) where the result will guide statin or aspirin decisions
Patients who want a simple, no-contrast screening tool
Patients with reduced kidney function where contrast is contraindicated
Younger patients (40s–early 50s) at intermediate risk without known CAD

When CCTA May Be Considered

Patients with atypical chest symptoms where coronary anatomy assessment is warranted
Situations where soft (non-calcified) plaque assessment is clinically relevant
Patients with a CAC of 0 but persistent cardiovascular symptoms (clinical judgment required)
Specific clinical scenarios where detailed coronary anatomical information changes management

Important: CCTA is not universally recommended for asymptomatic preventive screening. It involves contrast and radiation, and the decision to proceed should weigh the clinical benefit against these risks. Provider review is essential.

Getting a Provider Order for Either Study

Both CAC and CCTA require a provider order at most imaging facilities. If you're considering either study, a telehealth provider consultation is an efficient way to determine which — if either — is appropriate for your situation and to obtain an order if medically indicated.

Need a CAC or CCTA Provider Order?

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CT contrast studies require eGFR review. Orders issued only when medically appropriate.

Related Resources

This article is educational and does not constitute medical advice. Consult a licensed provider to determine which cardiovascular imaging study, if any, is appropriate for your individual situation. CT/MRI contrast studies require eGFR review.