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Letters
August 12, 2009

Evaluating Patients With Persistent Chest Pain and No Obstructive Coronary Artery Disease—Reply

JAMA. 2009;302(6):622-624. doi:10.1001/jama.2009.1097

In Reply: In response to Dr Seiden, the timing of translation of new research findings into clinical practice is always an issue of debate. When a body of evidence is ready for general use in clinical care will vary according to who is asked. Current evidence that supports coronary reactivity testing used in the patients in our article includes prognosis data documenting a 16% 5-year major adverse cardiac event rate in patients with signs and symptoms of ischemia with no obstructive CAD,1 suggesting that reassurance in this population is no longer appropriate. In addition, contemporary safety data have demonstrated that the risk of modern flow reserve testing in the hands of trained interventional cardiologists is lower than the risk of the condition, as reviewed in our article, and therefore can be considered in appropriate cases.

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