Lee JH, et al. - In 9,563 individuals without known coronary artery disease, researchers investigated if coronary artery calcium score (CACS) offers better risk stratification by providing incremental value beyond a traditional risk score according to renal function status. They used the modified MDRD formula to assess estimated glomerular filtration rate (eGFR, mL/min/1.73 m²), which was classified as: ≥90, 60-89, and <60. They categorized CACS as 0, 1-100, 101-400, and >400. They estimated hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days) by using multivariable Cox regression. There was a median follow-up of 24.5 months (IQR: 16.9-41.1), during which MACE was reported in 261 (2.7%) patients. Findings revealed improved risk stratification was allowed by CACS. Moreover, it offered incremental value beyond Framingham 10-year risk score (FRS) for predicting MACE, regardless of eGFR status. Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60.