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With Intermediate Risk of CAD, CTCA Valuable First Test

Computed tomography coronary angiography can determine need for invasive angiography

WEDNESDAY, May 19 (HealthDay News) -- As a tool for predicting the need for invasive coronary angiography (ICA), computed tomography coronary angiography (CTCA) appears to be most useful for patients at intermediate risk of coronary artery disease and may be more useful than stress testing in that population, according to research published May 18 in the Annals of Internal Medicine.

Annick C. Weustink, M.D., of Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues conducted an observational study of 517 patients referred for stress testing or ICA for evaluation of chest symptoms. All patients underwent both stress testing and CTCA.

The researchers found that CTCA was highly sensitive, approaching 100 percent, and was more accurate than stress testing. In patients with a low pre-test probability of disease, either a negative stress test or a negative CTCA suggested no need for ICA. When pre-test disease probability rose to intermediate levels, a positive CTCA was highly suggestive of a need for ICA, while a negative result suggested no need for further testing. With a high pre-test disease probability, physicians could proceed directly to ICA, without the intermediate step of non-invasive testing.

"In patients with a high pretest probability, neither stress testing nor CTCA offers much additional diagnostic value, and physicians can proceed directly to ICA. Additional studies, including cost-benefit analyses, are needed to confirm our findings before CTCA is accepted as a first-line diagnostic test in patients with an intermediate pretest probability of [coronary artery disease]," the authors write.

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