Abstract 4364754: Prevalence of Non-Coronary Incidental Findings Identified on CT Coronary Artery Calcium Scans Performed on Patients Enrolled in the CorCal Study. Do we need to keep track of them?

Background: Coronary Artery Calcium CT scans provide a coronary artery calcium score that may be very useful in ascertaining a patient’s future cardiovascular risk. However, besides the coronary artery calcium score itself, the CT scan may also identify many potentially significant non-coronary cardiac and other organ-related “incidental” findings. Whether potentially clinically substantial incidental findings can be determined frequently enough to justify the extra work required to perform a non-coronary review of every coronary artery CT scan is not known. Methods: The CorCal study randomized asymptomatic, otherwise healthy patients to receive ASCVD risk stratification using either the results of the Pooled Cohort Equation or a CT coronary calcium scan. By protocol, in addition to calculating a coronary artery calcium score, the interpreting radiologists carefully evaluated and reported all identified potentially significant non-coronary incidental findings. The prevalence of these findings, as well as whether any specific follow-up procedures were recommended, was recorded. Results: Out of 2,894 patients receiving coronary artery calcium scans, 247 (8.5%) received a report of a potentially significant incidental finding (See Table). Although more than half of the findings were lung-related, abnormalities were also identified in essentially every organ included in the CT scan images. A specific follow-up procedure was recommended in nearly two-thirds of findings. Conclusion: Among asymptomatic patients receiving a coronary artery calcium scan in the CorCal study, nearly one in ten received a report of a significant non-coronary incidental finding, of which almost two-thirds of those received a recommendation for a specific follow-up procedure. Whether this prevalence of incidental non-coronary findings justifies the time and expense of providing non-coronary over-reads for all coronary artery calcium scans remains to be determined.