In patients with stable chest pain and a risk factor–weighted clinical likelihood of 5%–15%, a coronary artery calcium score–weighted clinical likelihood (CACS-CL) strategy improved risk stratification, showing stronger associations with coronary artery disease and major adverse cardiovascular events than a CACS-only approach, while increasing downstream clinical management. Compared with an all–coronary computed tomography angiography strategy, the CACS-CL approach reduced unnecessary imaging and improved patient classification, though with a small trade-off in missed necessary testing, supporting its role as an efficient gatekeeping strategy pending further safety validation.

Source: BMC Medical Imaging