Diagnostic performance of coronary CTA for chest pain

By  |  November 18, 2008 | 

In patients with chest pain at intermediate risk for CAD, how does non-invasive coronary CTA compare to traditional invasive catheterization? In this multi-center study of patients with chest pain and no known CAD, 230 patients underwent both catheterization and CTA (abstract). Although the positive predictive value for detecting >50% and >70% stenosis was low (64% and 48%), the negative predictive values were 99%. Therefore, this is a good test for ruling out obstructive coronary disease in intermediate risk patients. As an editoralist notes (editorial), this study adds value to the current literature because it was performed at 16 centers (mixed academics and private), and without the traditional CTA patient exclusions (for heart rate >65, high coronary calcium scores, or obesity), providing diagnostic realities. However, the limitations of CTA remain, i.e. that it does not give any prognostic information (unless interpreted with the calcium score, or the severity / complexity of the plaques, of which there is large inter-observer variability) and that it results in a high number of false positive tests.

About the Author:

Danielle Scheurer
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.


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