SPC365

Impact of coronary calcification on lipid-lowering therapy decisions following coronary computed tomography with non-obstructive coronary disease or non-diagnostic result

Session: SESSÃO DE POSTERS 47 - AVALIAÇÃO CARDÍACA POR TC E/OU RM
Speaker: Mónica Amado

Congress: CPC 2025
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.2 Computed Tomography
Session Type: Cartazes
FP Number: ---
Authors: Mónica Amado; Adriana Vazão; Joana Pereira; André Martins; Carolina Gonçalves; Mariana Carvalho; Margarida Cabral; Luís Graça Santos; Hélia Martins

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Introduction: </span></strong><span style="font-size:11.0pt">Coronary computed tomography angiography </span><span style="font-size:11.0pt">(CCTA), as non-invasive method of choice for investigation of suspected symptomatic coronary artery disease (CAD), has been shown to be associated with lower cardiovascular (CV) outcomes. Such benefits seem mainly attributed to better management strategies, such as earlier statin prescription.</span> <span style="font-size:11.0pt">Moreover, even a non-diagnostic test can show coronary calcification (marker of advanced atherosclerosis) which may have important implications for lipid-lowering therapy (LLT) decisions.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Objectives: </span></strong><span style="font-size:11.0pt">To identify and characterize patients (pts) with positive calcium score (CaS) and non-obstructive CAD or non-diagnostic CCTA, and to evaluate subsequent LLT management according to the calcification degree.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods: </span></strong><span style="font-size:11.0pt">Single-center retrospective study of 354 pts with suspected obstructive CAD who underwent CCTA between June 2022 and September 2024. We selected pts with non-obstructive-CAD (absence of </span><span style="font-size:11.0pt">&ge;</span><span style="font-size:11.0pt">50% stenosis</span><span style="font-size:11.0pt">) or a </span><span style="font-size:11.0pt">non-diagnostic test (impossibility of excluding obstructive CAD in </span><span style="font-size:11.0pt">&ge;</span><span style="font-size:11.0pt">1 segment and absence of </span><span style="font-size:11.0pt">&ge;</span><span style="font-size:11.0pt">50% stenosis in interpretable segments) plus positive CaS. Group A included pts with a CaS=1-99 and Group B pts with values &gt;99. Demographic characteristics, </span><span style="font-size:11.0pt">LLT before and after CCTA and specific CCTA parameters were analyzed. Intensification of LLT was defined as: higher-potency statin switch; statin dose escalation; ezetimibe association; or &ge;2 of the above. SPSS v29 was used for </span><span style="font-size:11.0pt">statistical analyses.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results</span></strong><span style="font-size:11.0pt">: Overall, our sample included 116 pts (75.0% were male) with a mean age of 42.0 years. Group A included 65 pts (56.0%) and group B 51 pts (44.0%). Group B presented higher proportion of males (p=0.013) and an older mean age (p=0.022) </span><span style="font-size:11.0pt">[</span><span style="font-size:11.0pt">table 1</span><span style="font-size:11.0pt">]</span><span style="font-size:11.0pt">. Overall, after CCTA, LLT was initiated in 15.5% of pts, without differences between groups (16.9 vs 13.7%, p=0.929), and was withheld in 18.1% of this cohort with positive CaS. About one quarter of pts had their LLT intensified but with no differences between groups (23.1 vs 31.4%, p=0.467). &nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Conclusions: </span></strong><span style="font-size:11.0pt">In our study, pts with higher CaS were older and predominantly male, highlighting the role of demographic factors in coronary calcification. Despite some degree of LLT initiation and intensification following CCTA, no differences were observed according to the degree of coronary calcification and almost one fifth remained untreated. This raises some concern about some lack of awareness regarding the importance of coronary calcification for LLT tailoring.</span></span></span></p>