AI-CAC

U-Net-variant segmentation model that identifies and quantifies coronary artery calcium (CAC) directly from routine non-gated, non-contrast chest CT scans -- the kind ordered for lung-cancer screening or unrelated indications rather than a dedicated cardiac scan -- so that the tens of millions of such scans performed annually can be opportunistically screened for cardiovascular risk without any extra imaging. Predicted calcium masks are combined with the CT's Hounsfield units to compute an Agatston-equivalent score. Trained on 446 expert-segmented scans from 98 medical centers across the U.S. Department of Veterans Affairs national health system (capturing substantial heterogeneity in scanners and protocols) and benchmarked against 795 patients with a paired same-year gated CAC study: nongated AI-CAC differentiates zero-vs-nonzero and <100-vs->=100 Agatston categories with 89.4% (F1 0.93) and 87.3% (F1 0.89) accuracy respectively, and its score stratifies 10-year all-cause mortality (CAC 0 vs. >400: 25.4% vs. 60.2%, hazard ratio 3.49) and composite stroke/MI/death risk (33.5% vs. 63.8%, hazard ratio 3.00). In a simulated opportunistic-screening run across 8,052 low-dose CT scans, cardiologists confirmed 99.2% of patients flagged with AI-CAC >400 would benefit from lipid-lowering therapy. Code and trained model weights are both public under an MIT license.