Clinical significance of incidental findings on coronary CT angiography: Insights from a randomized controlled trial

J Nucl Cardiol. 2020 Dec;27(6):2306-2315. doi: 10.1007/s12350-019-01647-6. Epub 2019 Feb 20.

Abstract

Background: 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.

Methods: 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.

Results: 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].

Conclusions: Incidental findings on inpatient CCTAs performed for chest pain have a significant impact on treatment and imaging during and following hospital admission.

Keywords: CAD; CT; Image interpretation; MPI.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Pain
  • Adult
  • Aged
  • Chest Pain
  • Computed Tomography Angiography / methods*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Female
  • Humans
  • Incidental Findings*
  • Lung Diseases / complications
  • Lung Diseases / diagnostic imaging*
  • Male
  • Middle Aged
  • Myocardial Perfusion Imaging / methods*
  • Patient Admission
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome