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Introduction: Coronary artery calcium (CAC) scoring is used for both cardiovascular risk reclassification and as a gatekeeper for coronary computed tomography angiography (CCTA). The aims of this study were to assess to what extent CAC score results can reclassify the cardiovascular risk of patients without obstructive coronary artery disease (CAD) on CCTA, and to measure the proportion of these patients whose primary prevention medication is changed after the exam. Methods: In a retrospective analysis of a multicenter registry of individuals who underwent CCTA for suspected CAD during a two-year period, the Systematic COronary Risk Evaluation (SCORE) and Multi-Ethnic Study of Atherosclerosis (MESA) risk scores were calculated for each individual. In a subset of 184 patients, we also assessed the prescription of statins and antiplatelet agents before and after the test. Results: A total of 467 patients (248 women, mean age 60±9.10 years) were included. Median CAC score was 0 (interquartile range 0-40). Overall, 249 patients (53%) and 159 (34%) were classified as being of moderate/intermediate risk according to the SCORE and MESA risk scores, respectively. Among these, 29 (12%) and 30 (19%) patients had CAC score >100 AU, making them eligible for statin therapy. The inclusion of CAC scoring in the MESA score resulted in the reclassification of 215 patients (46%). The proportion of patients who were prescribed statins or antiplatelet agents did not change significantly after the test. Conclusion: CAC scoring can reclassify cardiovascular risk in a significant proportion of patients undergoing CCTA. Despite this, little change was seen in the prescription of statins and antiplatelet agents. Resumo: Introdução: O score de cálcio coronário (ScCa) é utilizado para reclassificação do risco cardiovascular e como gatekeeper para a realização de angiografia coronária por tomografia computadorizada (angio-TC). Os objetivos deste estudo são a avaliação do impacto dos resultados do ScCa na reclassificação do risco cardiovascular em doentes sem doença arterial coronária obstrutiva e a quantificação da proporção de doentes em contexto de prevenção primária cuja terapêutica foi modificada após o exame. Métodos: Análise retrospetiva de um registro multicêntrico de doentes submetidos a angio-TC por suspeita de doença arterial coronária significativa durante um período de dois anos. Os scores de risco Systematic COronary Risk Evaluation (SCORE) e Multi-Ethnic Study of Atherosclerosis (MESA) foram calculados em cada doente. Num subgrupo de 184 doentes, avaliámos a prescrição da estatina e da terapêutica antiagregante plaquetar antes e depois da realização do exame. Resultados: Foram incluídos 467 pacientes (248 mulheres, com idade média de 60 ± 9,10 anos). O ScCa mediano foi de 0 (intervalo interquartil de 0 a 40). Globalmente, 249 (53%) e 159 (34%) doentes foram classificados com risco moderado/intermédio, de acordo com os scores de risco SCORE e MESA, respetivamente. Neste grupo, 29 (12%) e 30 (19%) doentes apresentavam ScCa > 100, tornando-os elegíveis para terapêutica com estatinas. A inclusão dos resultados do ScCa no score de MESA resultou na reclassificação de 215 doentes (46%). A proporção de doentes que receberam estatinas ou agentes antiplaquetários não mudou significativamente após o exame. Conclusão: Os resultados do ScCa têm a capacidade de reclassificar o risco cardiovascular numa proporção significativa de pacientes submetidos a angio-TC. No entanto, pouco se alterou na prescrição de estatinas e terapia antiagregante plaquetar.

Introduction and Objectives: Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD), but envisage the use of risk modifiers, such as coronary artery calcium score (CACS), to refine patient selection for testing. We aimed to assess the cost-effectiveness (CE) of three different testing strategies in this population: (A) defer testing; (B) perform CACS, withholding further testing if CACS=0, and proceeding to coronary CT angiography (CCTA) if CACS>0; (C) CCTA in all., Methods: We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP <15% undergoing CACS followed by CCTA. Key input data included the prevalence of obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.1%)., Results: Not testing would correctly classify 89.7% of cases and at a cost of €121433 per 1000 patients. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases and cost €247116/1000 patients. Employing first-line CCTA would correctly classify all patients, at a cost of €271007/1000 diagnosed patients. The added cost for an additional correct diagnosis was €1366 for CACS±CCTA vs. no testing, and €2172 for CCTA vs. CACS±CCTA., Conclusions: CACS as a gatekeeper for further testing is cost-effective between a threshold of €1366 and €2172 per additional correct diagnosis. CCTA yields the most correct diagnoses and is cost-effective above a threshold of €2172., (Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Coronary artery calcium (CAC) scoring is used for both cardiovascular risk reclassification and as a gatekeeper for coronary computed tomography angiography (CCTA). The aims of this study were to assess to what extent CAC score results can reclassify the cardiovascular risk of patients without obstructive coronary artery disease (CAD) on CCTA, and to measure the proportion of these patients whose primary prevention medication is changed after the exam., Methods: In a retrospective analysis of a multicenter registry of individuals who underwent CCTA for suspected CAD during a two-year period, the Systematic COronary Risk Evaluation (SCORE) and Multi-Ethnic Study of Atherosclerosis (MESA) risk scores were calculated for each individual. In a subset of 184 patients, we also assessed the prescription of statins and antiplatelet agents before and after the test., Results: A total of 467 patients (248 women, mean age 60±9.10 years) were included. Median CAC score was 0 (interquartile range 0-40). Overall, 249 patients (53%) and 159 (34%) were classified as being of moderate/intermediate risk according to the SCORE and MESA risk scores, respectively. Among these, 29 (12%) and 30 (19%) patients had CAC score >100 AU, making them eligible for statin therapy. The inclusion of CAC scoring in the MESA score resulted in the reclassification of 215 patients (46%). The proportion of patients who were prescribed statins or antiplatelet agents did not change significantly after the test., Conclusion: CAC scoring can reclassify cardiovascular risk in a significant proportion of patients undergoing CCTA. Despite this, little change was seen in the prescription of statins and antiplatelet agents., (Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)