Coronary artery calcification is a marker of cardiovascular risk, but what is its association with qualitatively and quantitatively assessed plaque subtypes? In its most recent post-hoc analysis, the Scottish CT of the heart (SCOT-HEART) trial research team assessed CT images and five-year clinical outcomes in participants and discovered that calcium score is an imperfect prognostic measure, confirming current testing strategy guidelines which advocate the use of coronary CT angiography (CCTA) for quantitative assessment rather than calcium score for symptomatic patients.