Murphy Sarah J, Winchester David E
Department of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
J Eval Clin Pract. 2025 Jun;31(4):e70185. doi: 10.1111/jep.70185.
Coronary artery calcium (CAC) scoring plays a role in risk assessment for presence of atherosclerotic coronary heart disease (CHD). Among patients with known CHD, CAC has little or no value. Performing CAC on CHD patients is discouraged by ACC/AHA guidelines and the Choosing Wisely campaign. The extent to which this occurs in clinical practice is not well described.
We evaluated all UF Health patients since 2011 with known CHD who later underwent CAC scoring. We used our Integrated Data Repository to identify the cohort based on International Classification of Diseases and Current Procedural Terminology codes. Data from patient demographics, past medical history, CAC scoring results, ordering provider information and subsequent clinical management were recorded into a custom REDCap database for qualitative analysis. No prespecified statistical plan was performed as the investigation was intended as descriptive.
Upon reviewing all patients with known CHD, we found only 19 instances over 12 years where CAC scoring was ordered. Among these, 14 were men and 5 were women. A large percentage had a past medical history of DM (9, 47.4%) and hypertension (15, 78.9%) with a subclinical CHD diagnosis (17, 89.5%). Statin therapy was already initiated for 13 (68.4%). Most of the CAC scoring tests were ordered by cardiology attendings (10, 52.6%), and the justification most frequently provided was for risk stratification in patients with known CHD. Often (78.9%), there was no significant change in patient management or a slight alteration in medication therapy. One case resulted in percutaneous intervention.
CAC scoring was rarely ordered among patients with known CHD over a 12-year span. Professional society efforts towards encouraging high-value care may wish to consider more high-impact recommendations in the future.
冠状动脉钙化（CAC）评分在动脉粥样硬化性冠心病（CHD）存在的风险评估中发挥作用。在已知患有CHD的患者中，CAC几乎没有价值。美国心脏病学会（ACC）/美国心脏协会（AHA）指南以及“明智选择”运动不鼓励对CHD患者进行CAC检查。这种情况在临床实践中的发生程度尚无充分描述。
我们评估了自2011年以来所有已知患有CHD且后来接受CAC评分的佛罗里达大学健康中心患者。我们使用综合数据存储库根据国际疾病分类和当前程序术语代码识别该队列。将患者人口统计学、既往病史、CAC评分结果、开单医生信息以及后续临床管理的数据记录到自定义的REDCap数据库中进行定性分析。由于该调查旨在进行描述性研究，因此未执行预先指定的统计计划。
在审查所有已知患有CHD的患者时，我们发现在12年期间仅19例进行了CAC评分检查。其中，14例为男性，5例为女性。很大一部分患者有糖尿病既往病史（9例，47.4%）和高血压（15例，78.9%），且有亚临床CHD诊断（17例，89.5%）。13例（68.4%）患者已经开始他汀类药物治疗。大多数CAC评分检查是由心脏病学主治医生开单的（10例，52.6%），最常给出的理由是对已知患有CHD的患者进行风险分层。通常（78.9%），患者管理没有显著变化或药物治疗略有改变。1例患者接受了经皮介入治疗。
在12年期间，已知患有CHD的患者很少进行CAC评分检查。专业协会为鼓励高价值医疗所做的努力未来可能希望考虑提出更具影响力的建议。
