Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: Dr Hoffmann and colleagues1 showed noninvasive coronary angiography with multislice computed tomography (MSCT) using multisegment reconstruction to be a viable alternative to conventional coronary angiography in certain patient groups. I have a number of concerns about interpreting these results.
First, patients with previously stented coronary segments, who have an increased likelihood of significant stenoses in other vessel segments, were included in this study. These vessels can be easily identified even by an MSCT reader who is blinded to the results of the angiogram, which may lead to overestimation of diagnostic accuracy.2 This could have been prevented by excluding patients with stents, although this would have reduced the number studied to 91 patients with suspected disease and might have led to lower power and diagnostic accuracy.
Dewey M. Coronary Angiography With Multislice Computed Tomography. JAMA. 2005;294(18):2298-2299. doi:10.1001/jama.294.18.2298-a