Department of Radiology, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467, USA.
Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA.
J Nucl Cardiol. 2020 Dec;27(6):2306-2315. doi: 10.1007/s12350-019-01647-6. Epub 2019 Feb 20.
The effect of incidental findings from coronary computed tomography angiography (CCTA) on management has not been rigorously investigated. This study uses a control group to explore this relationship.
Analysis of data from a randomized controlled trial of acute chest pain patients admitted to telemetry was performed. Patients were randomized to undergo either CCTA (n = 200) or radionuclide myocardial perfusion imaging (MPI) (n = 200). Incidental findings were determined from imaging reports. Records were reviewed to determine subsequent management and imaging during and after hospitalization. Comparisons were performed using Fischer's exact tests.
386 incidental findings were found among 187 CCTA studies. No extra-cardiac incidental findings were noted in the MPI arm, which served as an effective control group. There were significantly more non-coronary medical workups during admission in the CCTA group compared to the MPI group [20% (39) vs. 12% (23), P = 0.038]. CCTA patients underwent significantly more resting echocardiography during the inpatient workup compared to the MPI group [38% (75) vs. 18% (55), P = 0.042]. CCTA patients underwent significantly more non-contrast chest CT exams in the year following admission compared to MPI patients [14% (27) vs. 7% (13) P = 0.029].
Incidental findings on inpatient CCTAs performed for chest pain have a significant impact on treatment and imaging during and following hospital admission.
冠状动脉 CT 血管造影（CCTA）偶然发现对治疗的影响尚未得到严格研究。本研究使用对照组来探讨这种关系。
对一项接受遥测的急性胸痛患者的随机对照试验的数据进行了分析。患者被随机分为 CCTA（n=200）或放射性核素心肌灌注成像（MPI）（n=200）组。偶然发现是从影像学报告中确定的。对记录进行审查，以确定住院期间和出院后的后续管理和影像学检查。使用 Fisher 精确检验进行比较。
在 187 例 CCTA 研究中发现了 386 例偶然发现。MPI 组未发现心脏外偶然发现，MPI 组可作为有效的对照组。与 MPI 组相比，CCTA 组在住院期间进行了更多的非冠状动脉医学检查[20%（39）比 12%（23），P=0.038]。与 MPI 组相比，CCTA 组在住院期间进行了更多的静息超声心动图检查[38%（75）比 18%（55），P=0.042]。与 MPI 组相比，CCTA 组在住院后一年内进行了更多的非对比胸部 CT 检查[14%（27）比 7%（13），P=0.029]。
因胸痛进行的住院期间 CCTA 偶然发现对治疗和住院期间及出院后的影像学检查有重大影响。
