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Editorials

CT Angiography

First Things First

Michael S. Lauer, MD, FACC, FAHA

From the Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Md.

Correspondence to Michael S. Lauer, MD, FACC, FAHA, 6701 Rockledge Dr, Room 10122, Bethesda, MD 20892. E-mail lauerm@nhlbi.nih.gov

Key Words: editorials • angiography • tomography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A learned person has 7 traits, the Babylonian Talmud teaches. Among them, "He discusses first things first...[and] about something he has not heard he says, ‘I have not heard.’"¹ Establishing proper priorities for inquiry and acknowledging ignorance are highly relevant in the ongoing debate raging around the rapid adoption of CT angiography.

Article see p 16

Investigators from leading centers now promote CT angiography as a major advance in diagnostics, making it possible for many patients to avoid invasive coronary angiography.² They provide 3 lines of evidence to make their case. First, in a number of cross-sectional patient-oriented studies, the diagnostic accuracy seems to be high, with claims of sensitivity and negative predictive value approaching or exceeding 95%.³ The most recent high-quality multicenter study using the more advanced 64-slice technology yielded less sanguine findings, though, with a reported sensitivity of 85% and a negative predictive value of only 83%; the investigators themselves concluded that "CT angiography cannot replace conventional coronary angiography at present."⁴

Second, preliminary investigations show that findings on CT angiography predict risk of major coronary events.⁵ Although not surprising, it is not clear whether prognostic information provided by CT is more or less accurate than that provided by conventional noninvasive tests, like measurement of exercise capacity or detection of myocardial scar or inducible ischemia by perfusion imaging or ultrasonography.

The third line of evidence is illustrated by the careful clinical epidemiological study presented by Chow et al⁶ in the current issue of Circulation Imaging. The investigators analyzed . . . [Full Text of this Article]

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