Coronary CT Angiography appears to be a better tool than stress testing alone for identifying patients with chest pain requiring invasive angiography. The SCOT-HEART investigators showed that patients showing disease on CT Angiography were less likely to show normal coronary arteries when they had the subsequent cardiac catheterization or angiogram. The SCOT-HEART study included 4146 patients who were randomized to receive standard care with or without coronary CT Angiography. David E Newby, MD, of the University of Edinburgh in the UK and associates concluded in the April on line edition of the Journal of the American College of Cardiology “in patients with suspected angina due to coronary heart disease, coronary CT angiography leads to more appropriate use of invasive angiography and alterations in preventative therapies that were associated with a halving of fatal and non-fatal myocardial infarction(s).” Reviewers of the study in editorial comments said that CT angiography had an edge over stress testing because of,” The ability to identify, quantify and characterize atherosclerosis.” CT angiography allows measurement non- invasively of fractional flow reserve providing a clear advantage to traditional stress testing. The major draw backs to CT angiography include cost of about $460 more than stress testing and exposure to ionizing radiation. A traditional CT scan exposes you to about 10 years’ worth of Chest X Ray level radiation.
For the practicing community physician this data will result in our patients with chest pain being sent for Coronary CT Angiography in the Emergency Department when presenting with chest pain, risk factors for heart disease and no clear cut diagnostic EKG changes instead of waiting for a cardiologist and technical team to be available to perform a stress test.