Hecht editorial: CT angiography is ready for prime time

CT angiography should replace stress testing in many clinical situations, according to an in press editorial by Harvey Hecht which is available at the American Journal of Cardiology website.

Hecht says that the shift to CT angiography represents a “paradigm shift,” and that CT angiography should be the test of choice “for whatever information is sought other than exercise capacity.” Stress tests should be used only “to establish the functional significance of intermediate stenoses demonstrated by CTA and for those patients with arrhythmias, very high coronary calcified plaque burdens, or renal dysfunction that prohibits CTA.”

Hecht, the article notes, is a paid speaker for Philips Medical Systems. Asked to comment on the editorial, Darren McGuire told CardioBrief that Hecht didn’t consider the “small but measureable risk of  the contrast required for CTA,” which is “specially relevant” for patients who have an abnormal CTA and then proceed to catheterization, since repeat exposure to contrast agents increases the renal risk.

McGuire also raises the issue of whether CTA is “really that much better than coronary calcium scanning,” since both modalities are extremely sensitive for atherosclerosis. He is “not completely convinced yet that the anatomic specificity (or lack thereof) of CTA justifies the increased cost and contrast administration” compared to calcium scans. Further, he notes that some centers now perform calcium scans for as little as $100.

For a very different perspective on CTA, you can read Steve Nissen’s editorial comment in JACC last year.

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  1. […] Hecht editorial: CT angiography is ready for prime time (June 2, 2009) […]

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