A meta-analysis revealed that the presence of coronary calcium had a sensitivity and specificity of 98% and 40%, respectively, in detecting significant stenoses [8]. Furthermore, numerous studies have reported on the value of CTCS in the prediction of the probability of obstructive CAD [1–4]. However, the incremental value (i.e. in addition to all known clinical predictors of CAD) of the CTCS as a continuous predictor of prevalent obstructive CAD is less well studied.