In this observational study, the authors aimed to define the clinical utility of stress
testing vs. computed tomography coronary angiography (CTCA) in determining the need
for invasive coronary angiography (ICA). Although the diagnostic accuracy of CTCA
has repeatedly been shown to supercede that of stress testing, the question of which
patients need CTCA has not been definitively shown. In this study, 517 patients referred
by their treating physicians received both stress testing and CTCA. CTCA was the most
clinically useful in populations with intermediate (defined as 20–80%) pretest probability.
In this population, a positive CTCA result yielded a post-test probability of 93%
and therefore a need to proceed with ICA. A negative CTCA result in this intermediate
population yielded a post-test probability of<1% and no indication to proceed with ICA. In patients with a high pretest probability
(> 80%), CTCA added no clinical value, as ICA was indicated regardless of CTCA results.
Likewise, CTCA did not add clinical value in patients with low pretest probability
of disease (< 20%); post-test probability sufficiently low to stop testing (< 5%)
was similar for stress testing and CTCA. CTCA, with its inherent risks of radiation
exposure and dye load, is likely not indicated in these patients.
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© 2010 Published by Elsevier Inc.
