The interplay of physician awareness and reporting of incidentally found coronary artery calcium on the clinical management of patients who underwent noncontrast chest computed tomography

Abstract

Studies have shown that coronary artery calcium (CAC) incidentally identified on a noncontrast chest computed tomography (NCCT) performed for noncardiac indications has diagnostic and prognostic value. The frequency by which radiologists report incidental CAC and its impact on patient management are unknown. This study included 204 consecutive patients (63 ± 17 years, 59% men) without a history of coronary artery disease referred for an NCCT for noncardiac indications. The presence of CAC was determined by an expert cardiologist and compared with the radiology report. For each patient, the medical record was reviewed for changes in medications. Physicians caring for these patients were surveyed regarding their awareness and the clinical importance of incidental CAC after their patients had been discharged from the hospital. There were 108 of 201 patients (53%) with a CAC score >0 as determined by an expert reader. The interpreting radiologist reported the presence of CAC in 74 of 108 patients (69%). Of the 74 patients, there was an increase in stain and aspirin prescription of 4% and 5%, respectively. Of the 132 physicians surveyed, 54% of physicians surveyed believed that CAC on an NCCT scan was analogous to the presence of coronary artery disease, 23% were aware that incidental CAC was reported, and only 4% said they would make medical management decisions based on the finding of incidental CAC. In conclusion, incidental CAC is under-reported by the interpreting radiologists and suggests an integral role for a cardiovascular imaging specialist. When incidental CAC is reported, physicians are not cognizant of the meaning and importance of this finding. This lack of knowledge is reflected in the negligible impact reported incidental CAC has on clinical management decisions.