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.
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]
By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system. One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light […]