Clinical and Economic Considerations of CT Coronary Calcium Screening and Its Role in Integrated BIG 3 Preventive Strategies

Introduction. Asymptomatic individuals account for almost 34% of all atherosclerosis-related deaths. Prognostic data says that cardiovascular diseases, chronic obstructive pulmonary disease, and lung cancer will continue to dominate the overall structure of causes of death until 2050. These conditions form the Big-3 Group, imposing a significant socioeconomic burden on the healthcare systems of most countries. CT-based methods enable the diagnosis of Big-3 diseases at the latent stage. It is suggested that single screening for multiple diseases (Big-3 screening) performed within one chest CT scan session improves the efficiency of examination at minimal additional cost. The economic potential of Big-3 screening has been demonstrated in early-stage technology assessments. Materials and methods. The authors analyzed CT innovations for coronary calcium scans, current AI-driven approaches to integrating combined protocols for CT imaging, and clinical effectiveness and cost-effectiveness of implementing these tools. Results. Advanced technology, such as dual-source computed tomography (DSCT) and photon-counting computed tomography (PCCT), showed a high reproducibility of coronary calcium screening results. These techniques allow the reliable evaluation of calcium score using the protocol for non-ECG-gated low-dose computed tomography (LDCT). Medical centers not equipped with high-resolution CT scanners can use AI algorithms instead. Such algorithms enhance the automatic grading of coronary calcium severity while also assessing the quality of images, validating the reliability of results, and making decisions on next steps in the patient journey, including further standard imaging tests. Conclusion. The optimization of protocols for CT screening, as well as patient inclusion and exclusion criteria, must be guided by the results of clinical trials and mathematical modeling. This will balance clinical and economic benefits against iatrogenic risks, thereby establishing the feasibility of coronary artery calcium screening within BIG-3-type strategies.

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