American College of Cardiology

View all recommendations from this society

Released February 23, 2023

Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease.

A coronary artery calcium (CAC) test is useful to assess risk and aid treatment decisions in many individuals without an established diagnosis of coronary artery disease. It does not contribute information for the risk assessment or treatment when the diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) has been established. According to the 2018 Guideline on the Management of Blood Cholesterol, clinical ASCVD includes acute coronary syndrome (ACS), history of myocardial infarction (MI), stable or unstable angina or coronary or other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm, all of atherosclerotic origin.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Cardiology (ACC) formed a Choosing Wisely workgroup of member leaders from the Board of Governors, subspecialty experts, and health policy specialists. The workgroup was tasked with identifying five clinical scenarios where specific tests, treatments, or procedures should be avoided for lack of benefit. These five recommendations were pulled from ACC’s existing appropriate use criteria (AUC) and clinical practice guidelines, selecting items that were either Rarely Appropriate AUC indications or Class III guideline recommendations. The ACC’s Clinical Policy Approval Committee and Science & Quality Committee then reviewed and approved the final five items.

ACC’s disclosure and conflict of interest policy can be found at


Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/ PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/
American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e285-e350.

Orringer CE, Blaha MJ, Blankstein R, et al. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol. 2021;15:33-60.