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We used multivariate logistic regression and receiver operating characteristics analysis containing anthropometric factors: body mass index, heart rate, and rhythm irregularity (model 1); and parameters used for pre-test likelihood estimation: age, sex, and type of angina (model 2); and also added total calcium score (model 3) to predict downstream testing.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>We analyzed 4120 (45.7% female, 57.9\u2009\u00b1\u200912.1\u00a0years) patients. Model 3 significantly outperformed models 1 and 2 (area under the curve, 0.84 [95% CI 0.83\u20130.86] vs. 0.56 [95% CI 0.54\u20130.58] and 0.72 [95% CI 0.70\u20130.74], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). For patients with sinus rhythm of 50\u00a0bpm, in case of non-specific angina, CACS above 435, 756, and 944; in atypical angina CACS above 381, 702, and 890; and in typical angina CACS above 316, 636, and 824 correspond to 50%, 80%, and 90% probability of further testing, respectively. However, higher heart rates and arrhythmias significantly decrease these cutoffs (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>CACS significantly increases the ability to identify patients in whom deferral from coronary CTA may be advised as CTA does not lead to a final decision regarding CAD management. Our results provide individualized cutoff values for given probabilities of the need of additional testing, which may facilitate personalized decision-making to perform or defer coronary CTA.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Key Points<\/jats:title>\n<jats:p><jats:italic>\u2022 Anthropometric parameters on their own are insufficient predictors of downstream testing. Adding parameters of the Diamond and Forrester pre-test likelihood test significantly increases the power of prediction.<\/jats:italic><\/jats:p>\n<jats:p><jats:italic>\u2022 Total CACS is the most important independent predictor to identify patients in whom coronary CTA may not be recommended as CTA does not lead to a final decision regarding CAD management.<\/jats:italic><\/jats:p>\n<jats:p><jats:italic>\u2022 We determined specific CACS cutoff values based on the probability of downstream testing by angina-, arrhythmia-, and heart rate\u2013based groups of patients to help individualize patient management.<\/jats:italic><\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00330-020-06921-7","type":"journal-article","created":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T12:02:45Z","timestamp":1589371365000},"page":"5499-5506","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Calcium scoring: a personalized probability assessment predicts the need for additional or alternative testing to coronary CT angiography"],"prefix":"10.1007","volume":"30","author":[{"given":"Judit","family":"Simon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Sz\u00e1raz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e1lint","family":"Szilveszter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexisz","family":"Panajotu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1d\u00e1m","family":"Jermendy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Bartykowszki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda","family":"Boussoussou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borb\u00e1la","family":"Vattay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zs\u00f3fia D\u00f3ra","family":"Drobni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e1l","family":"Maurovich-Horvat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-991X","authenticated-orcid":false,"given":"M\u00e1rton","family":"Kolossv\u00e1ry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"6921_CR1","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1016\/j.jacc.2008.07.031","volume":"52","author":"MJ Budoff","year":"2008","unstructured":"Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. 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