One major advantage that coronary CT angiography has over cardiac calcium scoring is that the former can distinguish whether areas of plaque in the coronary arteries are hard or soft.

Not that long ago, any plaque buildup in the coronary arteries was considered dangerous, and it was thought that larger areas of plaque were more risky.

People with heavy plaque buildup were automatically referred for angioplasty or cardiac bypass.

But now we know that more plaque is not necessarily worse. Though it sounds counterintuitive, it is actually the smaller, newer plaque that poses the most heart attack risk — not older, hardened plaque.

A coronary CT angiogram can distinguish between these types of plaque, while the coronary calcium score cannot.