Detection of non-zero CACS led to 68.4% starting/intensifying lipid-lowering therapy and 25.2% initiating aspirin, rising to >70% aspirin use with CACS≥300AU.
Does the identification of a non-zero coronary artery calcium score change medical treatment and diagnostic testing in primary prevention patients?
Detection of a non-zero CACS in primary prevention patients in Argentina was associated with significant intensification of preventive medical therapies and increased downstream anatomical testing for higher CACS values.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Coronary artery calcium score (CACS) is a recommended tool for cardiovascular risk assessment in primary prevention. While clinical practice guidelines endorse the use of statins and aspirin based on risk stratification determined by CACS, evidence regarding the impact of this tool on the intensification of therapeutic strategies in South American population remains limited. Purpose The objective of this study was to evaluate changes in medical treatment and the prescription of additional diagnostic tests following the identification of a non-zero CACS in a primary prevention population. Methods We conducted a retrospective analysis of primary prevention patients who underwent coronary artery calcium scoring at an institution in Argentina (March 2022-February 2025). Medical records of individuals with a non-zero CACS were reviewed to assess changes in medical treatment and the indication of anatomical studies after de CACS. Functional imaging conducted closer to the time of CACS were also collected. Additionally, we compared these clinical decisions according to CACS stratification: 1–99 Agatston units(AU), 100–299AU, and ≥300AU. Results Among 993 CACS performed, 427 patients had a CACS ≥1AU. Of these, 68.9% were men, with a mean age of 60 ±9.3 years. The prevalence of hypertension was 48.2%, dyslipidemia 74.7%, diabetes 6.6%, and smoking 18%. A total of 59% had a CACS between 1–99AU, 20.8% between 100–299AU, and 20.1% ≥300AU. Higher CACS values were associated with older age, male sex, and a higher prevalence of hypertension (Table 1). At the time of CACS assessment, 45% of patients were already receiving statins, and 6.1% were on aspirin. Following the study, 68.4% of patients either intensified or initiated lipid-lowering therapy, with a higher frequency in those with CACS≥100AU. On average, 25.2% of patients started aspirin therapy after the CACS report, with an indication rate exceeding 70% in those with CACS≥300AU (Table 2). A high frequency of functional imaging was observed across the population (69.9% in patients with CACS≥1); however, the rate of positive results for ischemia was only 3.6%, with no significant variations among CACS subgroups. Conversely, the prescription of anatomical studies (coronary catheterization or coronary CT angiography) was 4.6%, 9%, and 19.1% in the CACS 1–99, 100–299, and ≥300 groups, respectively (p 0.001). The proportion of patients requiring elective revascularization was 2.9% of the total, with a higher prevalence in those with CACS≥300 (Table 2). Conclusion(s) In this primary prevention population, the detection of a non-zero CACS was associated with significant changes in medical management, particularly in patients with higher CACS values. Although functional imaging was frequently ordered, only a minority yielded positive results. Further research is needed to better understand the role of this complementary studies in the risk assessment of primary prevention patients.Table 1 Table 2
Rodriguez et al. (Sat,) reported a other. Detection of non-zero CACS led to 68.4% starting/intensifying lipid-lowering therapy and 25.2% initiating aspirin, rising to >70% aspirin use with CACS≥300AU.