SPC365

Impact of coronary artery calcium on antiplatelet therapy decisions following coronary computed tomography with non-obstructive coronary disease or non-diagnostic result

Session: Sessão de Posters 16 - Mapeamento do risco: dos scores ao cálcio
Speaker: Mónica Amado

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Mónica Amado; Adriana Vazão; Joana Pereira; André Martins; Carolina Esteves; Mariana Carvalho; Luís Graça Santos; David Durão

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Coronary computed tomography angiography </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">(CCTA) is a non-invasive imaging modality for evaluating coronary artery disease (CAD). Expert consensus statements suggest that patients (pts) with a calcium score (CaS) &ge;300 Agatston units (AU) may have a cardiovascular (CV) risk equivalent to those with established atherosclerotic cardiovascular disease (ASCVD), even in the absence of obstructive CAD or the presence of a non-diagnostic CCTA, and that these pts may benefit from intensified preventive strategies, including antiplatelet therapy (APT).</span></span></span></span></p>

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

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">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 &ge;50% stenosis) or a non-diagnostic test for obstructive CAD (inability to exclude obstructive CAD in &ge;1 segment and absence of &ge;50% stenosis in interpretable segments) plus positive CaS. Group A included pts with CaS = 1-299 AU and Group B with CaS &ge;300 AU. Pts with a prior formal indication for APT were excluded.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: Overall, our study included 86 pts (67% male) with a mean age of 62.8&plusmn;9.2 years. Group A included 60 pts (69.8%) and Group B 26 pts (30.2%). Demographic characteristics were similar between groups [table 1], while group B presented a significantly higher prevalence of hypertension (60.0% vs 88.5%, <em>p</em>=0.009) and diabetes <em>mellitus</em> (13.3% vs. 50.0%, <em>p</em>&lt;0.001). APT was more commonly used both before and after CCTA in Group B (26.7% vs 53.8%, <em>p</em>=0.015; 28.3% vs 69.2%, <em>p</em>&lt;0.001, respectively). However, no differences were registered considering APT initiation rates following CCTA (3.3% vs 15.4%; p=0.065) and APT was withheld in 30.8% of group B pts despite CaS &ge; 300 AU.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">In our study, pts with higher calcium burden (group B) had a greater prevalence of CV risk factors, highlighting their role in ASCVD, and were also more likely to be on APT before and after CCTA, which may reflect a higher clinically perceived CV risk and consequent tendency towards more aggressive preventive strategies. However, the APT initiation rate in this group did not differ from pts with lower CaS category, drawing some concern to a likely lack of awareness regarding the potential benefits of introducing APT in pts with CaS &ge;300 AU.</span></span></span></span></p>