Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Eur Radiol. 2022 Jan;32(1):122-131. doi: 10.1007/s00330-021-07967-x. Epub 2021 Jun 15.
To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection.
This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection.
ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0).
In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients.
NCT Unique ID: 00844220 KEY POINTS: • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.
比较冠状动脉计算机断层扫描血管造影（CTA）和有创性冠状动脉造影（ICA）对相关心脏外发现（ECF）的检出情况，并评估其检出的潜在临床获益。
这是基于非典型心绞痛和疑似冠状动脉疾病（CAD）的临床指征进行 ICA 的患者的 ECF 预设亚分析，这些患者被纳入前瞻性单中心随机对照冠心病管理（CAD-Man）研究。需要立即治疗和/或进一步检查（包括额外的影像学检查）的 ECF 被定义为具有临床意义。我们评估了 329 例患者的 ECF 范围，并分析了其检出的潜在临床获益。
在 329 例患者中，107 例（32.5%；CTA：101/167，60.5%；ICA：6/162，3.7%；p<.001）检测到 ECF。59 例患者存在具有临床意义的 ECF（17.9%；CTA：55/167，32.9%；ICA：4/162，2.5%；p<.001）。在 CTA 组中，101 例 ECF 患者中有 13 例（12.9%）的 ECF 可能解释了非典型胸痛。开始治疗后，4 例（4.0%）胸痛改善，7 例（6.9%）胸痛缓解。33 例（10.0%；CTA：30/167，18.0%；ICA：3/162，1.9%）推荐进行随访影像学检查，26 例（7.9%；CTA：25/167，15.0%；ICA：1/162，0.6%）推荐进行额外的临床会诊。1 例（0.3%；CTA：1/167，0.6%；ICA：0）新诊断出恶性肿瘤。
在这项随机研究中，CTA 而非 ICA 检测到了具有临床意义的 ECF，这些 ECF 可能提示无 CAD 患者胸痛的其他潜在原因。因此，在这些患者中，CTA 可能可以避免进行 ICA。
NCT 唯一标识符：00844220
CTA 比 ICA 检测到的具有临床意义的 ECF 多十倍。
具有临床意义的可采取行动的 ECF 影响患者管理和治疗，因此可能改善胸痛。
CTA 检测到解释胸痛的 ECF 可能会避免进行 ICA。
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