Computed tomography coronary artery calcium scoring in primary care patients with non-acute chest pain
Chest pain is a common reason for people to visit their general practitioner (GP). Chest pain can sometimes be a sign of obstructive coronary artery disease (CAD), where arteries supplying the heart are narrowed due to fatty deposits. GPs need to identify patients who may have obstructive CAD while avoiding unnecessary referrals.
In this thesis, Moniek Koopman investigated whether a computed tomography (CT) scan measuring the amount of calcium in the coronary arteries, the coronary artery calcium score (CT-CACS), can help GPs assess patients with atypical chest pain or non-specific chest complaints. A low CT-CACS score, particularly a score of zero, indicates a very low likelihood of obstructive CAD and may provide reassurance.
The CONCRETE trial showed that giving GPs access to CT-CACS reduced cardiologist referrals by nearly half, while detecting obstructive CAD at a similar rate to usual care. CT-CACS also helped identify patients who benefit from cardiovascular risk management, including lifestyle changes and preventive treatment. Patients generally valued the test because it was quick, easy, and provided clear diagnostic information.
The study also showed that CT-CACS should support, rather than replace, the GP’s clinical judgement. Considering calcium levels in relation to age and sex was valuable for women and helped identify some cases of CAD that might otherwise have been missed.
Overall, the findings suggest that CT-CACS is a safe and useful first-line test for low-risk patients with chest pain in primary care. It may reassure patients, guide preventive treatment, and make the assessment of chest pain more efficient.
Find the full thesis here: Computed tomography coronary artery calcium scoring in primary care patients with non-acute chest pain
