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

Goldman, Lauren H.; Lerer, Rikah; Shabrang, Cyrus; Travin, Mark I.; Levsky, Jeffrey M.

doi:10.1007/s12350-019-01647-6

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…Our data about incidental findings with CCTA are limited to one study ( 35 ) which showed increased incidental findings contributing to increased in-hospital workup compared with SOC. Such increases could ultimately lead to longer LOSs ( 43 ).…”

Section: Discussionmentioning

confidence: 89%

“…One study, a subanalysis of the Prospective Randomized Outcome Trial Comparing Radionuclide Stress Myocardial Perfusion Imaging and ECG-gated Coronary CT Angiography (PROSPECT) trial, reported more incidental findings in the CCTA arm compared with SOC arm ( 35 ). The authors reported 386 incidental findings in 187 participants who underwent CCTA.…”

Section: Resultsmentioning

confidence: 99%

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Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis

Barbosa,

Canan,

et al. 2023

Radiology: Cardiothoracic Imaging

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Purpose To perform a living systematic review and meta-analysis of randomized controlled trials comparing the effectiveness of coronary CT angiography (CCTA) and standard of care (SOC) in the evaluation of acute chest pain (ACP). Materials and Methods Multiple electronic databases were systematically searched, with the most recent search conducted on October 31, 2022. Studies were stratified into two groups according to the pretest probability for acute coronary syndrome (group 1 with predominantly low-to-intermediate risk vs group 2 with high risk). A meta-regression analysis was also conducted using participant risk, type of SOC used, and the use or nonuse of high-sensitivity troponins as independent variables. Results The final analysis included 22 randomized controlled trials (9379 total participants; 4956 assigned to CCTA arms and 4423 to SOC arms). There was a 14% reduction in the length of stay and a 17% reduction in immediate costs for the CCTA arm compared with the SOC arm. In group 1, the length of stay was 17% shorter and costs were 21% lower using CCTA. There was no evidence of differences in referrals to invasive coronary angiography, myocardial infarction, mortality, rate of hospitalization, further stress testing, or readmissions between CCTA and SOC arms. There were more revascularizations (relative risk, 1.45) and medication changes (relative risk, 1.33) in participants with low-to-intermediate acute coronary syndrome risk and increased radiation exposure in high-risk participants (mean difference, 7.24 mSv) in the CCTA arm compared with the SOC arm. The meta-regression analysis found significant differences between CCTA and SOC arms for rate of hospitalization, further stress testing, and medication changes depending on the type of SOC ( P < .05). Conclusion The results support the use of CCTA as a safe, rapid, and less expensive in the short term strategy to exclude acute coronary syndrome in low- to intermediate-risk patients presenting with acute chest pain. Keywords: Acute Coronary Syndrome, Chest Pain, Emergency Department, Coronary Computed Tomography, Usual Care Supplemental material is available for this article. Published under a CC BY 4.0 license.

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Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis

Barbosa,

Canan,

et al. 2023

Radiology: Cardiothoracic Imaging

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“…Patients in the cardiac CT group underwent subsequently more inpatient testing ( P = 0.042) and outpatient CT chest in the year following admission (14% vs. 3%, P = 0.029). 72 Therefore, incidental findings often result in more downstream testing that will incur higher cost and burden to the healthcare system.…”

Section: Extra Cardiac Imagingmentioning

confidence: 99%

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2020: positron emission tomography, computed tomography, and magnetic resonance

AlJaroudi

Hage

2021

Journal of Nuclear Cardiology

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Although the year 2020 was different from other years in many respects, the Journal of Nuclear Cardiology published excellent articles pertaining to imaging in patients with cardiovascular disease due to the dedication of the investigators in our field all over the world. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field and provide the reader with an opportunity to review a wide selection of articles. We will focus on publications dealing with positron emission tomography, computed tomography, and magnetic resonance and hope that you will find this review helpful.

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“…In the current issue of the Journal, Goldman et al provides an interesting analysis on incidental findings identified on CCTA performed in the setting of randomized clinical trial. 14 The trial this substudy is based upon should a trial of 400 patients with acute chest pain randomized to either CCTA or stress myocardial perfusion imaging (MPI). The original study showed no significant differences between CCTA and MPI in outcomes (cardiac catheterization not leading to revascularization) or cardiac related resource utilization over 40 months.…”

mentioning

confidence: 99%

Incidental findings on cardiac computed tomography: No new emergencies to declare!

Malahfji

Al‐Mallah

2020

Journal of Nuclear Cardiology

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

Cited by 7 publications

References 41 publications

Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis

Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2020: positron emission tomography, computed tomography, and magnetic resonance

Incidental findings on cardiac computed tomography: No new emergencies to declare!

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