CT angiography, underuse, overuse, or appropriate use?

[摘要] Recently, cardiologists have started serious debates over expensive medical technologies, questioning the conclusions that high-resolution cardiac CT images are almost as effective as conventional angiograms. This debate reveals a deep gap among cardiologists over the use of multi-slice CT angiography. A number of physicians have immediately embraced CT technology and installed expensive CT scanners in their hospitals in order to detect early signs of coronary artery disease. Other doctors, however, argue that these high-tech devices drive up healthcare costs and offer no proven benefits. In a recent study in the New England Journal of Medicine (2008;35:2324–36), investigators identified 291 patients with symptoms of coronary artery disease who were studied with a 64-slice CT scanner. The CT angiograms accurately identified 85% of the patients who had significant stenoses and 90% of the patients without coronary artery disease. The authors stated that noninvasive CT angiography was almost as accurate as conventional angiography. Nevertheless, it was also concluded that CT angiography is not able to replace conventional coronary angiography at present. More outspoken was the ACCURACY trial (JACC 2008:52:1724–32) which showed in 230 patients a 99% negative predictive value for CT angiography, establishing this method as an effective noninvasive alternative to conventional angiography to rule out obstructive coronary artery stenosis.

[学科分类] 心脏病和心血管学