“It seems that CCTA results in more procedures on patients, such as cardiac catheterization and coronary artery bypass surgery,” Dr. Levsky observed. “We’d like to know if these procedures are really helping people. In some situations these procedures are life-saving. At other times, when we do more procedures, unfortunately, they don’t help patients.”
During the trial, the authors also developed a registry of patients who didn’t meet the trial’s inclusion criteria or refused to participate in the trial.
“The registry does not have the constraints of the strict entry and exclusion criteria of the randomized trial. We are studying the registry patients to get an idea about how the tests performed in the wider population,” he said.
“In our decision making, we should have a good balance between the radiation concerns, which favor stress echocardiography, and the comprehensiveness of how much we think we need to evaluate the patient at the present time,” he explained. “Coronary CT gives us much more information about subclinical heart disease and other potential chest pain causes.”
In a phone interview, Dr. Pamela S. Douglas of the Duke Clinical Research Institute of Duke University in Durham, North Carolina, commended the inclusion of minority racial and ethnic groups in the trial.
“But the small size is a concern, and the authors weren’t clear about what the patients were hospitalized for,” said Dr. Douglas, who wrote an editorial about the study.
“I think there are many ‘best’ tests to do in many patient settings. We should use the available test that fits the question being asked for that patient—whether it’s a diagnostic or a prognostic question—as well as that fits the patient’s characteristics,” she noted. “I’m in favor of precision testing, where the test choice is tailored to the individual rather than the one-size-fits-all, always doing the same test, whether it’s stress echo or CT.”