Is Coronary CTA Really the Bad Boy of Cardiology?

Chris P. Kaiser, Editor

It seems that CT imaging gets a lot of negative press around this time of year. In November 2007, the New England Journal of Medicine published an article by Brenner and Hall that said CT scans could be responsible for as much as 2 percent of all cancers in the United States in the next 20 to 30 years due the radiation exposure.

This year, the NEJM published an editorial that questioned the government’s continued financial support of coronary CT angiography (CCTA) in the face of limited evidence. The limited evidence spoken of in the commentary referred to results from the CorE 64 study that found some redeeming qualities of CCTA, but concluded it cannot replace diagnostic catheter angiography.

Perhaps what we have here is more sensationalism than considered thought. The CorE 64 study did not set out to compare CCTA with catheter angiography. It merely sought to determine CT’s efficacy to identify stenosis, which they showed it does fairly well.

The multicenter CorE 64 study essentially confirms numerous single-center studies that CCTA is a good triage tool for determining if a particular patient population with chest pain can be sent home or sent to diagnostic cath. And senior author Dr. João Lima has said as much.

Naysayers have a point that CCTA has enjoyed meteoric success without the concomitant evidence, but, as Dr. Udo Hoffmann told Cardiovascular Business News, that doesn’t mean we should stop reimbursing for the test. If that happened, the science would stop as well and there’d be no more evidence either for or against CCTA.

Other reports of the debacle quoted Dr. Rita Redberg, one of the authors of the NEJM commentary, as saying the commentary was written before the study was published and that they included a mention of the study when NEJM editors decided to publish their commentary with the study. In subsequent interviews, Redberg seems to soften the vitriol directed at the CorE 64 study.

The problem is, in this day of news on-demand, one has to follow all the threads to figure out the truth. Let’s hope the mainstream press—as well as medical journals—can connect the dots in a way that doesn’t condemn CCTA outright, but merely acknowledges that our data for its efficacy as a triage tool has been bolstered.

On this or any other topic, please feel free to send me your comments.

Chris P. Kaiser, Editor
ckaiser@cardiovascularbusiness.com