Letter by Vrints Regarding Article, “Coronary Computed Tomography Angiography in the Evaluation of Chest Pain of Suspected Cardiac Origin”
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To the Editor:
In a recent Clinician Update, Bittencourt et al1 promoted the use of coronary computed tomography angiography (CCTA) as a first-line diagnostic test in the assessment of patients with suspected stable angina.Their opinion is based on a meta-analysis of 4 recent randomized clinical trials that compared CCTA as first-line test with ischemia testing.2 In this meta-analysis, first-line use of CCTA resulted in a significant reduction in the incidence of myocardial infarction with no effect on all-cause mortality over a median follow-up of 2 years, but an increased downstream utilization of revascularization compared with usual care.2
Identification and revascularization of a subgroup with severe coronary artery disease (CAD) …