We thank Drs Cheng and Kelleher for their interest in our recent article on the use of EBCT in diagnosing CAD. We appreciate their comments and the opportunity to respond.
First, the objective of our article was "to estimate the accuracy of EBCT in diagnosing obstructive CAD."1 Toward that objective, we believe that our concluding remarks were appropriate: EBCT is reasonably accurate at detecting obstructive CAD in patients undergoing coronary angiography with an accuracy similar to exercise stress testing. In fact, the recent ACC/AHA expert consensus document cited by Dr Cheng clearly supports our finding, stating that the "predictive accuracy of the tests is similar."2 Dr Cheng's comments imply that our conclusion leads us to endorse the widespread clinical use of EBCT, unlike the authors of the ACC/AHA document, since we made no firm recommendations regarding its clinical use. We disagree. While we share his view that the medical community is ultimately responsible for "advocating clinically effective and cost-effective" care, the objective of our article was to better define the diagnostic accuracy of EBCT. Accordingly, we limited our discussion on cost-related issues, as these were concerns we were not directly investigating.
Nallamothu BK, Saint S, Rubenfire M, Fendrick AM. Electron-Beam Computed Tomography as a Population Screening Tool—Reply. Arch Intern Med. 2001;161(21):2625. doi: