Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease.

Autor:	Brix GS; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Rasmussen LD; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Rohde PD; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Schmidt SE; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Nyegaard M; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Douglas PS; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Newby DE; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK., Williams MC; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK., Foldyna B; Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA., Knuuti J; Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu, Turku, Finland., Bøttcher M; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Winther S; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: sw@dadlnet.dk.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2024 Jun; Vol. 17 (6), pp. 625-639. Date of Electronic Publication: 2024 Jan 03.
DOI:	10.1016/j.jcmg.2023.11.008
Abstrakt:	Background: Coronary artery calcium scoring (CACS) improves management of chest pain patients. However, it is unknown whether the benefit of CACS is dependent on the clinical likelihood (CL). Objectives: This study aims to investigate for which patients CACS has the greatest benefit when added to a CL model. Methods: Based on data from a clinical database, the CL of obstructive coronary artery disease (CAD) was calculated for 39,837 patients referred for cardiac imaging due to symptoms suggestive of obstructive CAD. Patients were categorized according to the risk factor-weighted (RF-CL) model (very low, ≤5%; low, >5 to ≤15%; moderate >15 to ≤50%; high, >50%). CL was then recalculated incorporating the CACS result (CACS-CL). Reclassification rates and the number needed to test with CACS to reclassify patients were calculated and validated in 3 independent cohorts (n = 9,635). Results: In total, 15,358 (39%) patients were down- or upclassified after including CACS. Reclassification rates were 8%, 75%, 53%, and 30% in the very low, low, moderate, and high RF-CL categories, respectively. Reclassification to very low CACS-CL occurred in 48% of reclassified patients. The number needed to test to reclassify 1 patient from low RF-CL to very low CACS-CL was 2.1 with consistency across age, sex, and cohorts. CACS-CL correlated better to obstructive CAD prevalence than RF-CL. Conclusions: Added to an RF-CL model for obstructive CAD, CACS identifies more patients unlikely to benefit from further testing. The number needed to test with CACS to reclassify patients depends on the pretest RF-CL and is lowest in patients with low (>5% to ≤15%) likelihood of CAD. Competing Interests: Funding Support and Author Disclosures Drs Newby and Williams have received support from the British Heart Foundation (FS/ICRF/20/26002, CH/09/002, RG/16/10/32375, RE/18/5/34216). The PROMISE study was supported by grants from the National Heart, Lung, and Blood Institute (R01HL098237, R01HL098236, R01HL098305, and R01HL098235). Dr Winther has received support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). Dr Williams has been a speaker for Canon Medical Systems, Siemens Healthineers, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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