Disclaimer: I despise CCTA for low-risk chest pain in the ED. It leads to additional unnecessary testing, interventions, and harms that outweigh the risk of coronary events in its target population. Our liability-sensitive practice has us evaluating an ever-increasing cohort of low- and (mostly) zero-risk young chest pain patients, and this is purported to be a test of choice for identifying a zero-zero risk population.
But there are just far too many false positives that have coronary artery disease of uncertain clinical significance.
This is a Korean study that compared 1000 matched controls that did not undergo CCTA with 1000 who did. 215 asymptomatic patients had positive CCTA – defined as any atherosclerotic plaque. 52 had >50% stenosis and 21 had >75% stenosis.
Their control cohort and their CCTA cohort were very similar – and 55-59% low risk, 34-29% intermediate, and 10% high risk based on NCEP risk stratification.
And their control group had a grand total of 1 cardiac event within their 18 month follow-up period, as did a single person in their positive CCTA group. However, the CCTA group ended up with more additional testing and cardiac revascularization procedures during their follow-up time frames – with no change in outcomes.
Now, these are asymptomatic patients chosen for screening – not the same as our chest pain patients in the ED – but it’s another call for caution regarding overtesting and overtreating.