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ECFs requiring immediate therapy and\/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ECFs were detected in 107 of 329 patients (32.5%; CTA: 101\/167, 60.5%; ICA: 6\/162, 3.7%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55\/167, 32.9%; ICA: 4\/162, 2.5%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30\/167, 18.0%; ICA: 3\/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25\/167, 15.0%; ICA: 1\/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1\/167, 0.6%; ICA: 0).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      NCT Unique ID:\n                      <jats:bold>00844220<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:italic>\u2022 CTA detects ten times more clinically relevant ECFs than ICA.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>\u2022 Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>\u2022 Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-021-07967-x","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T03:02:56Z","timestamp":1623726176000},"page":"122-131","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography"],"prefix":"10.1007","volume":"32","author":[{"given":"Dominik","family":"Laskowski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Feger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Bosserdt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Kendziora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Rief","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henryk","family":"Dreger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Estrella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-2733","authenticated-orcid":false,"given":"Marc","family":"Dewey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"7967_CR1","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1007\/s00330-018-5688-4","volume":"29","author":"P Karius","year":"2019","unstructured":"Karius P, Lembcke A, Sokolowski FC et al (2019) Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease. 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He also received grant support from German Research Foundation (DFG) in the Heisenberg Program (DE 1361\/14-1), graduate program on quantitative biomedical imaging (BIOQIC, GRK 2260\/1), for fractal analysis of myocardial perfusion (DE 1361\/18-1), and the Priority Programme Radiomics for the investigation of coronary plaque and coronary flow (DE 1361\/19-1 [428222922] and 20-1 [428223139] in SPP 2177\/1). He also received funding from the Berlin University Alliance (GC_SC_PC 27) and from the Digital Health Accelerator of the Berlin Institute of Health. Prof. Dewey has received lecture fees from Canon, Guerbet. Prof. Dewey is European Society of Radiology (ESR) Research Chair (2019\u20132022) and the opinions expressed in this article are the author\u2019s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Research Chair is on a voluntary basis and only remuneration of travel expenses occurs. Prof. Dewey is also the editor of <i>Cardiac CT<\/i>, published by Springer Nature, and offers hands-on courses on CT imaging (\n                      \n                      ). Institutional master research agreements exist with Siemens, General Electric, Philips, and Canon. The terms of these arrangements are managed by the legal department of Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin. Professor Dewey holds a joint patent with Florian Michallek on dynamic perfusion analysis using fractal analysis (PCT\/EP2016\/071551). Other authors declared no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"\u2022 retrospective\u2022 randomized controlled trial\u2022 performed at one institution","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}