Coronary disease & ACSRandomised controlled trial
Coronary calcium scoring in the evaluation of stable chest pain in general practice: a cluster-randomised trial
- pragmatic, non-blinded implementation study that cluster-randomised 101 Dutch GP offices
Authors' conclusion
In this pragmatic, primary-care implementation and proof-of-concept trial, CACS was an effective diagnostic test for stable chest pain patients with (very) low likelihood of OCAD. CACS reduced unnecessary cardiology referrals and enhanced individual preventive care, without demonstrable practice-level impact on CVRM registrations.
Study context
- Population
- GP patients aged ≥40 (men) or ≥45 (women) years, without known CAD, with possible cardiac or non-cardiac chest pain, in Dutch GP officespatients in per protocol analysis for patient-level outcomes, 101 Dutch GP offices cluster-randomised · coronary artery calcium score (CACS) arm 466 · standard of care (SOC) arm 117
- Participants
- 583 patients
- Comparison
- CACS versus SOC
- CACSn = 466
- SOCn = 117
- Primary endpoint
- Proportional increase in cardiovascular risk management (CVRM) registrations at GP office level
- Follow-up
- 2-year
Primary result
As reported in the abstract
CACS
+0.3%
SOC
+0.2%
P = 0.77
Secondary outcomes
| Outcome | CACS | SOC | modelled difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Cardiologist referral rate · 47.1% relative reduction in cardiologist referrals with CACS · per protocol analysis | 42.5% | 80.3% | 31.3% (14.8%–47.8%) | ||
| −200204060Difference (linear scale) |
CVRM enrolment · more CACS patients enrolled
P < 0.01
| Outcome | CACS | SOC | difference (95% CI) | P value |
|---|---|---|---|---|
| OCAD detection rate · not significantly different | 4.9 | 7.7% | P = 0.14 | |
| Cardiologist referral by CACS level | +85.7% (79.4%–91.9%) |
- Obstructive coronary artery disease (OCAD) diagnosis by CACS level — OR 9.08 (95% CI 4.20 to 19.67) for OCAD diagnosis with higher CACS
- 9.08
- Cardiologist referral by CACS level: CACS 0 8.4%
- Cardiologist referral by CACS level: CACS ≥400 94.2%
- OCAD diagnosis by CACS level: CACS 0 0%
- OCAD diagnosis by CACS level: CACS ≥400 21.2%
Original publication
Coronary calcium scoring in the evaluation of stable chest pain in general practice: a cluster-randomised trial. Heart. Published 16 August 2026. doi:10.1136/heartjnl-2025-327687
Summarised from the published abstract; every number is checked against it