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.
|
November 18, 2008 |
0 
Share This Post
About the Author: Danielle Scheurer
Danielle Scheurer, MD, MSCR, SFHM is a clinical hospitalist and the Chief Quality Officer at the Medical University of South Carolina in Charleston, South Carolina, where she also serves as 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 is also the President of SHM's Board of Directors and previously served as Physician Editor of The Hospitalist, SHM's monthly newsmagazine.
Categories
Related Posts
July 31, 2020 |
0While all of us see patients who smoke in their 70s or 80s, due to their limited lifespan from COPD, DM, malignancy, etc., and their expressed wishes to continue tobacco, we keep our admonitions to a minimum. We accept our patient has become learned enough through life to make their own decisions and accept whatever […]
November 8, 2019 |
0Do you have a stack of journals piling up on your desk, beside your bed or in your email inbox? In 1950, medical knowledge was estimated to double every 50 years, but now the doubling time is every few months. At this rate, it is impossible to keep up with the literature, but a group […]
June 18, 2018 |
0Fill in the Blanks: Q: “The diagnosis of type 2 MI is associated with a _____ prognosis. ___% of patients will live five years after their diagnosis.” The answer is a) POOR and b) a staggering 40%. I did not know that. However, what I am aware of is the ambiguity around Type 2 MIs and […]
Leave A Comment