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

Gitte S. Brix; Laust D. Rasmussen; Palle D. Rohde; Samuel E. Schmidt; Mette Nyegaard; Pamela S. Douglas; David E. Newby; Michelle C. Williams; Borek Foldyna; Juhani Knuuti; Morten Bøttcher; Simon Winther

doi:10.1016/j.jcmg.2023.11.008

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

Gitte S. Brix, Laust D. Rasmussen, Palle D. Rohde, Samuel E. Schmidt, Mette Nyegaard, Pamela S. Douglas, David E. Newby, Michelle C. Williams, Borek Foldyna, Juhani Knuuti, Morten Bøttcher, Simon Winther^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

9 Citations (Scopus)

Abstract

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.

Original language	English
Journal	JACC: Cardiovascular Imaging
Volume	17
Issue	6
Pages (from-to)	625-639
Number of pages	15
ISSN	1936-878X
DOIs	https://doi.org/10.1016/j.jcmg.2023.11.008
Publication status	Published - Jun 2024

Keywords

chronic coronary syndrome
clinical likelihood
clinical management
coronary artery calcium score
coronary prognosis
Severity of Illness Index
Predictive Value of Tests
Reproducibility of Results
Prognosis
Risk Assessment
Humans
Middle Aged
Risk Factors
Decision Support Techniques
Male
Computed Tomography Angiography
Coronary Artery Disease/diagnostic imaging
Coronary Angiography
Vascular Calcification/diagnostic imaging
Clinical Decision-Making
Female
Aged
Retrospective Studies
Databases, Factual

Access to Document

10.1016/j.jcmg.2023.11.008

Library access?

Check availability with the Royal Danish Library

Cite this

Brix, G. S., Rasmussen, L. D., Rohde, P. D., Schmidt, S. E., Nyegaard, M., Douglas, P. S., Newby, D. E., Williams, M. C., Foldyna, B., Knuuti, J., Bøttcher, M., & Winther, S. (2024). Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease. JACC: Cardiovascular Imaging, 17(6), 625-639. https://doi.org/10.1016/j.jcmg.2023.11.008

@article{3c2530c58b4d438384e64adb9f6b7879,

title = "Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease",

abstract = "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.",

keywords = "chronic coronary syndrome, clinical likelihood, clinical management, coronary artery calcium score, coronary prognosis, Severity of Illness Index, Predictive Value of Tests, Reproducibility of Results, Prognosis, Risk Assessment, Humans, Middle Aged, Risk Factors, Decision Support Techniques, Male, Computed Tomography Angiography, Coronary Artery Disease/diagnostic imaging, Coronary Angiography, Vascular Calcification/diagnostic imaging, Clinical Decision-Making, Female, Aged, Retrospective Studies, Databases, Factual",

author = "Brix, {Gitte S.} and Rasmussen, {Laust D.} and Rohde, {Palle D.} and Schmidt, {Samuel E.} and Mette Nyegaard and Douglas, {Pamela S.} and Newby, {David E.} and Williams, {Michelle C.} and Borek Foldyna and Juhani Knuuti and Morten B{\o}ttcher and Simon Winther",

year = "2024",

month = jun,

doi = "10.1016/j.jcmg.2023.11.008",

language = "English",

volume = "17",

pages = "625--639",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "6",

}

Brix, GS , Rasmussen, LD, Rohde, PD, Schmidt, SE, Nyegaard, M, Douglas, PS, Newby, DE, Williams, MC, Foldyna, B, Knuuti, J, Bøttcher, M & Winther, S 2024, 'Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease', JACC: Cardiovascular Imaging, vol. 17, no. 6, pp. 625-639. https://doi.org/10.1016/j.jcmg.2023.11.008

Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease. / Brix, Gitte S.; Rasmussen, Laust D.; Rohde, Palle D. et al.
In: JACC: Cardiovascular Imaging, Vol. 17, No. 6, 06.2024, p. 625-639.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease

AU - Brix, Gitte S.

AU - Rasmussen, Laust D.

AU - Rohde, Palle D.

AU - Schmidt, Samuel E.

AU - Nyegaard, Mette

AU - Douglas, Pamela S.

AU - Newby, David E.

AU - Williams, Michelle C.

AU - Foldyna, Borek

AU - Knuuti, Juhani

AU - Bøttcher, Morten

AU - Winther, Simon

PY - 2024/6

Y1 - 2024/6

N2 - 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.

AB - 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.

KW - chronic coronary syndrome

KW - clinical likelihood

KW - clinical management

KW - coronary artery calcium score

KW - coronary prognosis

KW - Severity of Illness Index

KW - Predictive Value of Tests

KW - Reproducibility of Results

KW - Prognosis

KW - Risk Assessment

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Decision Support Techniques

KW - Male

KW - Computed Tomography Angiography

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Angiography

KW - Vascular Calcification/diagnostic imaging

KW - Clinical Decision-Making

KW - Female

KW - Aged

KW - Retrospective Studies

KW - Databases, Factual

UR - http://www.scopus.com/inward/record.url?scp=85189968750&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2023.11.008

DO - 10.1016/j.jcmg.2023.11.008

M3 - Journal article

C2 - 38180413

SN - 1936-878X

VL - 17

SP - 625

EP - 639

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 6

ER -

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

Abstract

Keywords

Access to Document

Library access?

Other files and links

Fingerprint

Cite this