Department of Medicine, Alfred Health, Melbourne, Vic, Australia.
Department of Medicine, Peninsula Health, Frankston, Vic, Australia.
Heart Lung Circ. 2023 Oct;32(10):1222-1229. doi: 10.1016/j.hlc.2023.07.011. Epub 2023 Sep 25.
We investigated the prevalence of incidental coronary artery calcifications (CAC) from non-electrocardiogram (ECG)-gated computed tomography (CT) chest (both contrast and non-contrast) for inpatients. We also assessed for downstream investigation and statin prescription from the inpatient teams. Incidental CAC are frequent findings on non-ECG-gated CT chest. It is associated with adverse prognosis in multiple patient cohorts.
All non-ECG-gated CT chest done as inpatients from a single centre referred from 1 January 2022 to 31 December 2022 with reported incidental CAC were reviewed for inclusion. Patients who had a history of known coronary artery disease, history of coronary stent or bypass, and presence of cardiac devices were excluded.
Total of 123 patients were included, making the prevalence 6.2% (123/1,980). The median age is 76 years (interquartile range 69-85) and predominantly male at 54.5%. The majority of CT chest done were contrasted scans (91.1%). Only 26.8% of CAC were reported on severity with visual quantification, with 7.3% each reported for both moderate and severe CAC. Only 2.4% of CAC were reported in the conclusion of the CT report. Most of these patients were asymptomatic (34.1%). A total of 20.3% of patients had further tests done. Inpatient hospital mortality was 8.1%. About 23.6% and 34.1% of patients were on aspirin and statin therapy respectively at baseline. There was only 1 patient (1.2%) who was prescribed with new statin therapy on discharge.
Incidental CAC is prevalent in inpatient settings and remains under-recognised by ordering clinicians, with low prescription rate of statin therapy. Practice-changing measures to standardise reporting of incidental CAC is needed to identify patients with subclinical coronary disease and initiate preventive interventions.
我们调查了非心电图（ECG）门控计算机断层扫描（CT）胸部（包括对比剂和非对比剂）住院患者偶然发现的冠状动脉钙化（CAC）的患病率。我们还评估了住院团队的下游检查和他汀类药物处方情况。非 ECG 门控 CT 胸部偶然 CAC 是常见的发现。它与多个患者队列的不良预后相关。
我们回顾了 2022 年 1 月 1 日至 2022 年 12 月 31 日期间，从一家中心转诊的所有非 ECG 门控 CT 胸部检查结果，报告偶然 CAC 的住院患者。排除已知冠状动脉疾病病史、冠状动脉支架或旁路手术史和心脏设备存在的患者。
共纳入 123 例患者，患病率为 6.2%（123/1,980）。中位年龄为 76 岁（四分位距 69-85 岁），男性占 54.5%。大多数 CT 胸部检查为对比剂扫描（91.1%）。仅 26.8%的 CAC 通过视觉量化报告严重程度，分别有 7.3%报告为中度和重度 CAC。仅在 CT 报告的结论中报告了 2.4%的 CAC。这些患者大多无症状（34.1%）。共有 20.3%的患者进行了进一步检查。住院期间死亡率为 8.1%。约 23.6%和 34.1%的患者在基线时有阿司匹林和他汀类药物治疗。只有 1 名患者（1.2%）在出院时被开了新的他汀类药物治疗。
在住院环境中偶然 CAC 很常见，但医嘱临床医生对其认识不足，他汀类药物治疗的处方率较低。需要采取改变实践的措施，规范偶然 CAC 的报告，以确定患有亚临床冠状动脉疾病的患者并启动预防干预措施。
