Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project).
Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project).
复制标题
偶然冠状动脉钙：对以前的非门控胸部计算机断层扫描进行机会性筛查以提高他汀类药物的使用率（NOTIFY-1 项目）。
DOI：
10.1161/circulationaha.122.062746
复制
发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
Maron,DavidJ
中科院分区：
文献类型：
--
作者：
Sandhu,AlexanderT;Rodriguez,Fatima;Ngo,Summer;Patel,BhavikN;Mastrodicasa,Domenico;Eng,David;Khandwala,Nishith;Balla,Sujana;Sousa,Doug;Maron,DavidJ
背景冠状动脉钙化（CAC）可以通过非增强胸部CT扫描来识别，但这一发现并不总是被纳入到护理中。深度学习算法实现了非增强胸部CT扫描的机会性CAC筛查。我们的目的是评估通知临床医生和患者意外冠状动脉钙化对他汀类药物治疗的影响。MethodsNOTIFY-1（意外冠状动脉钙化质量改进项目）是斯坦福大学医疗保健系统的一个随机质量改进项目。没有已知动脉粥样硬化性心血管疾病或既往他汀类药物处方的患者在2014年至2019年期间使用经验证的深度学习算法和放射科医生确认的既往非增强胸部CT扫描中筛查CAC。偶然CAC患者被随机分配到通知初级保健临床医生和患者与常规护理。通知包括CAC的患者特定图像和关于他汀类药物使用的指南建议。主要结果是他汀类药物处方在6 months.ResultsAmong 2113例患者谁符合初始临床纳入标准，CAC确定的算法在424例患者。在病历审查和额外的排除后，放射科医生在194名患者中的173名（89.2%）中证实了CAC，这些患者被随机分配到通知或常规护理组。6个月时，通知组的他汀类药物处方率为51.2%（44/86），常规治疗组为6.9%（6/87）（P<0.001）。在通知组中也有更多的冠状动脉疾病检测（15.1% [13/86] vs 2.3% [2/87];P=0.008）。结论：在临床医生和患者通知后，既往非增强胸部CT扫描的诊断学CAC筛查导致他汀类药物处方的显著增加。需要进一步的研究来确定这种方法是否可以减少动脉粥样硬化性心血管疾病事件。RegistrationURL：https://www.clinicaltrials.gov; Unique identifier：NCT 04789278。
BackgroundCoronary artery calcium (CAC) can be identified on nongated chest computed tomography (CT) scans, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of nongated chest CT scans. Our objective was to evaluate the effect of notifying clinicians and patients of incidental CAC on statin initiation.MethodsNOTIFY-1 (Incidental Coronary Calcification Quality Improvement Project) was a randomized quality improvement project in the Stanford Health Care System. Patients without known atherosclerotic cardiovascular disease or a previous statin prescription were screened for CAC on a previous nongated chest CT scan from 2014 to 2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomly assigned to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months.ResultsAmong 2113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After chart review and additional exclusions were made, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomly assigned to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (P<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] versus 2.3% [2/87];P=0.008).ConclusionsOpportunistic CAC screening of previous nongated chest CT scans followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce atherosclerotic cardiovascular disease events.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT04789278.