Carlos V Serrano Jr1, Marcelo Oranges2, Vitor Brunaldi2, Alexandre de M Soeiro1, Tatiana Andreucci Torres1, José Carlos Nicolau1, José Antonio F Ramires11Heart Institute, 2Medical School, University of São Paulo, BrazilAbstract: The role of calcification in coronary artery disease is gaining importance, both in research studies and in clinical application. Calcified plaque has long been considered to be the most important atherosclerotic plaque within the arterial tree and frequently presents a challenge for percutaneous intervention. Current investigations have shown that plaque calcification has a dynamic course that is closely related to the magnitude of vascular inflammation. Numerous inflammatory factors synthesized during the early stages of atherosclerosis induce the expression and activation of osteoblast-like cells localized in the arterial wall that produce calcium. There is no doubt that the role of these factors in calcification associated with coronary artery disease could be a crucial strategic point in prevention and treatment. A number of diagnostic imaging methods have been developed in recent years, but their performance needs to be improved. In this context, we undertook an update on coronary calcification, focusing on physiopathology, clinical implications, and imaging techniques.Keywords: vascular smooth muscle cells, atherosclerotic plaques, vascular calcification