Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
Heart. 2022 Aug 25;108(18):1461-1466. doi: 10.1136/heartjnl-2021-320698.
When reporting coronary CT angiography (CCTA), extracardiac structures are routinely assessed, usually on a wide field-of-view (FOV) reconstruction. We performed a retrospective observational cross-sectional study to investigate the impact of incidental extracardiac abnormalities on resource utilisation and treatment, and cost-effectiveness.
All patients undergoing CCTA at a single institution between January 2012 and March 2020 were identified. The indication for CCTA was chest pain or dyspnoea in >90%. Patients with ≥1 significant extracardiac findings were selected. Clinical follow-up, investigations and treatment were documented, and costs were calculated.
4340 patients underwent CCTA; 717 extracardiac abnormalities were identified in 687 individuals (15.8%; age 62±12 years; male 336, 49%). The abnormality was already known in 162 (23.6%). Lung nodules and cysts were the most common abnormalities (296, 43.1%). Clinical and/or imaging follow-up was pursued in 292 patients (42.5%). Treatment was required by 14 patients (0.3% of the entire population), including lung resection for adenocarcinoma in six (0.1%). All but two abnormalities (both adenocarcinomas) were identifiable on the limited cardiac FOV. The cost of reporting (£20) and follow-up (£33) of extracardiac abnormalities was £53 per patient. The cost per discounted quality-adjusted life year was £23 930, increasing to £46 674 for reporting the wide FOV rather than the cardiac FOV alone.
Extracardiac abnormalities are common on CCTA, but identification and follow-up are costly. The few requiring treatment are usually identifiable without review of the wide FOV. The way in which CCTAs are scrutinised for extracardiac abnormalities in a resource-limited healthcare system should be questioned.
在报告冠状动脉 CT 血管造影（CCTA）时，通常会在宽视野（FOV）重建上对心脏外结构进行常规评估。我们进行了一项回顾性观察性横断面研究，以调查偶然发现的心脏外异常对资源利用、治疗和成本效益的影响。
在 2012 年 1 月至 2020 年 3 月期间，在一家机构接受 CCTA 的所有患者均被确定。CCTA 的适应证为胸痛或呼吸困难>90%。选择有≥1 个显著心脏外发现的患者。记录了临床随访、检查和治疗情况，并计算了成本。
4340 例患者接受了 CCTA；在 687 名患者（15.8%；年龄 62±12 岁；男性 336 名，占 49%）中发现了 717 个心脏外异常。162 个（23.6%）异常已为已知。肺结节和囊肿是最常见的异常（296 个，占 43.1%）。292 例患者（42.5%）进行了临床和/或影像学随访。14 例患者（占总人口的 0.3%）需要治疗，包括 6 例腺癌的肺切除术（0.1%）。除了两个异常（均为腺癌）外，所有异常均能在有限的心脏 FOV 中识别。心脏外异常的报告（£20）和随访（£33）费用为每位患者£53。每个折扣后的质量调整生命年的成本为£23930，而不是仅报告宽 FOV，成本为£46674。
在 CCTA 中，心脏外异常很常见，但识别和随访成本高昂。需要治疗的异常通常可以在不检查宽 FOV 的情况下识别。在资源有限的医疗保健系统中，应该对 CCTA 检查心脏外异常的方式提出质疑。
