Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population

John W. McEvoy, Michael J. Blaha, Khurram Nasir, Yeonyee E. Yoon, Eue Keun Choi, Ik Sung Cho, Eun Ju Chun, Sang Il Choi, Juan J. Rivera, Roger S. Blumenthal, Hyuk Jae Chang

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Abstract

Background: The impact of screening coronary computed tomographic angiography (CCTA) on physician and patient behavior is unclear. Methods: We studied asymptomatic patients from a health-screening program. Our study population comprised 1000 patients who underwent CCTA as part of a prior study and a matched control group of 1000 patients who did not. We assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months. Results: A total of 215 patients in the CCTA group had coronary atherosclerosis (CCTA positive). Medication use was increased in the CCTA-positive group compared with both the CCTA-negative (no atherosclerosis) and control groups at 90 days (statin use, 34% vs 5% vs 8%, respectively; aspirin use, 40% vs 5% vs 8%, respectively), and 18 months (statin use, 20% vs 3% vs 6%, respectively; aspirin use, 26% vs 3% vs 6%, respectively). After multivariable risk adjustment, the odds ratios for statin and aspirin use in the CCTA-positive group at 18 months were 3.3 (95% confidence interval [CI], 1.3-8.3) and 4.2 (95% CI, 1.8-9.6), respectively. At 90 days, in the total CCTA group vs controls, there were more secondary tests (55 [5%] vs 22 [2%]; P<.001) and revascularizations (13 [1%] vs 1 [0.1%]; P<.001). One cardiovascular event occurred in each group over 18 months. Conclusions: An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA should not be considered a justifiable test at this time.

Original languageEnglish
Pages (from-to)1260-1268
Number of pages9
JournalArchives of Internal Medicine
Volume171
Issue number14
DOIs
Publication statusPublished - 2011 Jul 25

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Angiography
Physicians
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Population
Aspirin
Control Groups
Confidence Intervals
Risk Adjustment
Coronary Artery Disease
Atherosclerosis
Research Design
Referral and Consultation
Odds Ratio
Health

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

McEvoy, John W. ; Blaha, Michael J. ; Nasir, Khurram ; Yoon, Yeonyee E. ; Choi, Eue Keun ; Cho, Ik Sung ; Chun, Eun Ju ; Choi, Sang Il ; Rivera, Juan J. ; Blumenthal, Roger S. ; Chang, Hyuk Jae. / Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population. In: Archives of Internal Medicine. 2011 ; Vol. 171, No. 14. pp. 1260-1268.
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title = "Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population",
abstract = "Background: The impact of screening coronary computed tomographic angiography (CCTA) on physician and patient behavior is unclear. Methods: We studied asymptomatic patients from a health-screening program. Our study population comprised 1000 patients who underwent CCTA as part of a prior study and a matched control group of 1000 patients who did not. We assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months. Results: A total of 215 patients in the CCTA group had coronary atherosclerosis (CCTA positive). Medication use was increased in the CCTA-positive group compared with both the CCTA-negative (no atherosclerosis) and control groups at 90 days (statin use, 34{\%} vs 5{\%} vs 8{\%}, respectively; aspirin use, 40{\%} vs 5{\%} vs 8{\%}, respectively), and 18 months (statin use, 20{\%} vs 3{\%} vs 6{\%}, respectively; aspirin use, 26{\%} vs 3{\%} vs 6{\%}, respectively). After multivariable risk adjustment, the odds ratios for statin and aspirin use in the CCTA-positive group at 18 months were 3.3 (95{\%} confidence interval [CI], 1.3-8.3) and 4.2 (95{\%} CI, 1.8-9.6), respectively. At 90 days, in the total CCTA group vs controls, there were more secondary tests (55 [5{\%}] vs 22 [2{\%}]; P<.001) and revascularizations (13 [1{\%}] vs 1 [0.1{\%}]; P<.001). One cardiovascular event occurred in each group over 18 months. Conclusions: An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA should not be considered a justifiable test at this time.",
author = "McEvoy, {John W.} and Blaha, {Michael J.} and Khurram Nasir and Yoon, {Yeonyee E.} and Choi, {Eue Keun} and Cho, {Ik Sung} and Chun, {Eun Ju} and Choi, {Sang Il} and Rivera, {Juan J.} and Blumenthal, {Roger S.} and Chang, {Hyuk Jae}",
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McEvoy, JW, Blaha, MJ, Nasir, K, Yoon, YE, Choi, EK, Cho, IS, Chun, EJ, Choi, SI, Rivera, JJ, Blumenthal, RS & Chang, HJ 2011, 'Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population', Archives of Internal Medicine, vol. 171, no. 14, pp. 1260-1268. https://doi.org/10.1001/archinternmed.2011.204

Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population. / McEvoy, John W.; Blaha, Michael J.; Nasir, Khurram; Yoon, Yeonyee E.; Choi, Eue Keun; Cho, Ik Sung; Chun, Eun Ju; Choi, Sang Il; Rivera, Juan J.; Blumenthal, Roger S.; Chang, Hyuk Jae.

In: Archives of Internal Medicine, Vol. 171, No. 14, 25.07.2011, p. 1260-1268.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population

AU - McEvoy, John W.

AU - Blaha, Michael J.

AU - Nasir, Khurram

AU - Yoon, Yeonyee E.

AU - Choi, Eue Keun

AU - Cho, Ik Sung

AU - Chun, Eun Ju

AU - Choi, Sang Il

AU - Rivera, Juan J.

AU - Blumenthal, Roger S.

AU - Chang, Hyuk Jae

PY - 2011/7/25

Y1 - 2011/7/25

N2 - Background: The impact of screening coronary computed tomographic angiography (CCTA) on physician and patient behavior is unclear. Methods: We studied asymptomatic patients from a health-screening program. Our study population comprised 1000 patients who underwent CCTA as part of a prior study and a matched control group of 1000 patients who did not. We assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months. Results: A total of 215 patients in the CCTA group had coronary atherosclerosis (CCTA positive). Medication use was increased in the CCTA-positive group compared with both the CCTA-negative (no atherosclerosis) and control groups at 90 days (statin use, 34% vs 5% vs 8%, respectively; aspirin use, 40% vs 5% vs 8%, respectively), and 18 months (statin use, 20% vs 3% vs 6%, respectively; aspirin use, 26% vs 3% vs 6%, respectively). After multivariable risk adjustment, the odds ratios for statin and aspirin use in the CCTA-positive group at 18 months were 3.3 (95% confidence interval [CI], 1.3-8.3) and 4.2 (95% CI, 1.8-9.6), respectively. At 90 days, in the total CCTA group vs controls, there were more secondary tests (55 [5%] vs 22 [2%]; P<.001) and revascularizations (13 [1%] vs 1 [0.1%]; P<.001). One cardiovascular event occurred in each group over 18 months. Conclusions: An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA should not be considered a justifiable test at this time.

AB - Background: The impact of screening coronary computed tomographic angiography (CCTA) on physician and patient behavior is unclear. Methods: We studied asymptomatic patients from a health-screening program. Our study population comprised 1000 patients who underwent CCTA as part of a prior study and a matched control group of 1000 patients who did not. We assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months. Results: A total of 215 patients in the CCTA group had coronary atherosclerosis (CCTA positive). Medication use was increased in the CCTA-positive group compared with both the CCTA-negative (no atherosclerosis) and control groups at 90 days (statin use, 34% vs 5% vs 8%, respectively; aspirin use, 40% vs 5% vs 8%, respectively), and 18 months (statin use, 20% vs 3% vs 6%, respectively; aspirin use, 26% vs 3% vs 6%, respectively). After multivariable risk adjustment, the odds ratios for statin and aspirin use in the CCTA-positive group at 18 months were 3.3 (95% confidence interval [CI], 1.3-8.3) and 4.2 (95% CI, 1.8-9.6), respectively. At 90 days, in the total CCTA group vs controls, there were more secondary tests (55 [5%] vs 22 [2%]; P<.001) and revascularizations (13 [1%] vs 1 [0.1%]; P<.001). One cardiovascular event occurred in each group over 18 months. Conclusions: An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA should not be considered a justifiable test at this time.

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U2 - 10.1001/archinternmed.2011.204

DO - 10.1001/archinternmed.2011.204

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