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The risk factor weighted clinical likelihood (RF-CL) model provides likelihood estimation of obstructive coronary artery disease. This study investigated the prognostic effect of coronary CTA vs. usual care by RF-CL estimates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Large-scale studies randomized patients (N = 13 748) with stable chest pain to coronary CTA as part of the initial work-up in addition to or instead of usual care including functional testing. Patients were stratified according to RF-CL estimates [RF-CL: very-low (\u22645%), low (&amp;gt;5%\u201315%), and moderate\/high (&amp;gt;15%)]. The primary endpoint was myocardial infarction or death at 3 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The primary endpoint occurred in 313 (2.3%) patients. Event rates were similar in patients allocated to coronary CTA vs. usual care [risk difference (RD) 0.3%, hazard ratio (HR) 0.84 (95% CI 0.67\u20131.05)]. Overall, 33%, 44%, and 23% patients had very-low, low, and moderate\/high RF-CL. Risk was similar in patients with very low and moderate\/high RF-CL allocated to coronary CTA vs. usual care [very low: RD 0.3%, HR 1.27 (0.74\u20132.16); moderate\/high: RD 0.5%, HR 0.88 (0.63\u20131.23)]. Conversely, patients with low RF-CL undergoing coronary CTA had lower event rates [RD 0.7%, HR 0.67 (95% CI 0.47\u20130.97)]. The number needed to test using coronary CTA to prevent one event within 3 years was 143.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite an overall good prognosis, low RF-CL patients have reduced risk of myocardial infarction or death when allocated to coronary CTA vs. usual care. Risk is similar in patients with very-low and moderate\/high likelihood.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehae742","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T16:25:17Z","timestamp":1729873517000},"page":"473-483","source":"Crossref","is-referenced-by-count":15,"title":["Clinical risk prediction, coronary computed tomography angiography, and cardiovascular events in new-onset chest pain: the PROMISE and SCOT-HEART trials"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2790-2608","authenticated-orcid":false,"given":"Laust Dupont","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital , Herning ,","place":["Denmark"]},{"name":"Department of Cardiology, Aalborg University Hospital , Aalborg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0917-634X","authenticated-orcid":false,"given":"Samuel Emil","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology, Aalborg University , Aalborg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhani","family":"Knuuti","sequence":"additional","affiliation":[{"name":"Heart Center, Turku University Hospital , Turku ,","place":["Finland"]},{"name":"Turku PET Centre, Turku University Hospital and University of Turku , Turku ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9263-5702","authenticated-orcid":false,"given":"Christiaan","family":"Vrints","sequence":"additional","affiliation":[{"name":"Research Group Cardiovascular Diseases, Department GENCOR, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp ,","place":["Belgium"]},{"name":"Department of Cardiology, Antwerp University Hospital (UZA) , Edegem ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2116-2370","authenticated-orcid":false,"given":"Morten","family":"B\u00f8ttcher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital , Herning ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-4827","authenticated-orcid":false,"given":"Borek","family":"Foldyna","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Department of Radiology, Mass. 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