To evaluate the effectiveness of a coronary artery calcium score–weighted clinical likelihood strategy in classifying patients with stable chest pain and reducing unnecessary coronary computed tomography angiography (CCTA).
Key Findings:
9.8% of patients experienced major adverse cardiovascular events (MACE) during a median follow-up of 76 months.
The CACS-weighted model improved diagnostic classification of CAD with net reclassification improvement ranging from 6.7% to 18.7%.
The CACS-weighted strategy reduced imaging utilization, requiring three calcium score tests to avoid one angiography study.
Interpretation:
The CACS-weighted clinical likelihood strategy effectively classified patients and reduced unnecessary CCTA, indicating a potential for improved clinical management in stable chest pain cases.
Limitations:
Observational design may have introduced verification bias.
Findings are specific to stable chest pain and not applicable to acute presentations.
Cost-effectiveness of the CACS-weighted strategy requires further investigation.
Conclusion:
The CACS-weighted clinical likelihood model has greater potential to guide clinical management effectively and safely compared to the CACS strategy alone.
