Coronary Artery Calcium for Major Adverse Cardiovascular Event Prediction (SILICAS Study)

The SILICAS (Subclinical Coronary Artery Disease—An Indicator of Cardiovascular Adverse Symptoms) prospective observational study followed 588 patients referred for coronary calcium scoring to determine whether CAC score predicted major adverse cardiovascular events (MACE) over follow-up.

Higher CAC scores were associated with significantly greater MACE rates, with the risk gradient increasing across CAC categories. CAC zero patients had very low event rates; intermediate and high CAC categories had progressively higher risk. The results are consistent with the broader CAC literature, including MESA and other large cohort studies, in confirming the prognostic gradient across CAC strata.

The study is a smaller confirmation of established CAC literature in a Polish cohort referred for cardiac risk assessment. The referral population design introduces selection bias — patients already suspected of having coronary disease — which limits generalizability to true asymptomatic primary prevention populations. The primary value of the SILICAS results is as additional confirmation of a well-established prognostic relationship in a European, non-MESA population.

For clinical practice, the results reinforce the utility of CAC scoring for risk stratification in patients with intermediate traditional risk factor burden, particularly when treatment decisions are uncertain.

We rate the evidence limited. A modestly-sized prospective observational study confirming established CAC prognostic relationships in a European clinical population — supporting but not extending the primary evidence base.