Abstract
ObjectivesNoncardiac findings are common on coronary computed tomography angiography (CCTA). We assessed the clinical impact of noncardiac findings, and potential changes to surveillance scans with the application of new lung nodule guidelines.MethodsThis substudy of the SCOT-HEART randomized controlled trial assessed noncardiac findings identified on CCTA. Clinically significant noncardiac findings were those causing symptoms or requiring further investigation, follow-up or treatment. Lung nodule follow-up was undertaken following the 2005 Fleischner guidelines. The potential impact of the 2015 British Thoracic Society (BTS) and the 2017 Fleischner guidelines was assessed.ResultsCCTA was performed in 1,778 patients and noncardiac findings were identified in 677 (38%). In 173 patients (10%) the abnormal findings were clinically significant and in 55 patients (3%) the findings were the cause of symptoms. Follow-up imaging was recommended in 136 patients (7.6%) and additional clinic consultations were organized in 46 patients (2.6%). Malignancy was diagnosed in 7 patients (0.4%). Application of the new lung nodule guidelines would have reduced the number of patients undergoing a follow-up CT scan: 68 fewer with the 2015 BTS guidelines and 78 fewer with the 2017 Fleischner guidelines; none of these patients subsequently developed malignancy.ConclusionsClinically significant noncardiac findings are identified in 10% of patients undergoing CCTA. Application of new lung nodule guidelines will reduce the cost of surveillance, without the risk of missing malignancy.Key Points• Clinically significant noncardiac findings occur in 10% of patients undergoing CCTA.• Noncardiac findings may be an important treatable cause of chest pain• Further imaging investigations for noncardiac findings were recommended in 8% of patients after CCTA.• New lung nodule follow-up guidelines will result in cost savings.
Highlights
The SCOT-HEART prospective multicentre randomized controlled trial showed that coronary computed tomography angiography (CCTA) in patients with suspected angina due to coronary heart disease improves diagnostic certainty, changes management and reduces future rates of myocardial infarction. [9] This has led to important changes in national guidelines which recommend the increased use of CCTA in patients with stable chest pain [1]
Patients with moderate or obstructive coronary artery disease were slightly more likely to have noncardiac findings than patients with mild disease or normal coronary arteries (RR 1.18, 95% CI 1.05–1.34; p = 0.005)
There were no differences in age, gender, body mass index, presence of diabetes mellitus or presence of obstructive coronary artery disease between those with significant and those with nonsignificant noncardiac findings
Summary
The SCOT-HEART prospective multicentre randomized controlled trial showed that coronary computed tomography angiography (CCTA) in patients with suspected angina due to coronary heart disease improves diagnostic certainty, changes management and reduces future rates of myocardial infarction. [9] This has led to important changes in national guidelines which recommend the increased use of CCTA in patients with stable chest pain [1]. [9] This has led to important changes in national guidelines which recommend the increased use of CCTA in patients with stable chest pain [1]. The follow-up of incidental lung nodules identified on computed tomography (CT) is dependent on local, national and international guidelines. In the SCOT-HEART trial, the 2005 Fleischner Society guidelines [2] were used to provide recommendations regarding lung nodule follow-up. These have recently been superseded by the 2015 British Thoracic Society (BTS) guidelines [3] and the 2017 Fleischner Society guidelines [4]. It is important to identify lung nodules on CCTA which may require further investigation and management
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