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JAMA Diagnostic Test Interpretation
September 23, 2020

Coronary Computed Tomography Angiography

Author Affiliations
  • 1Charité–Universitätsmedizin Berlin, Berlin, Germany
JAMA. 2020;324(14):1455-1456. doi:10.1001/jama.2020.10831

A 56-year-old woman presented to her cardiologist with stable atypical chest pain. A 20% pretest probability of coronary artery disease (CAD) was estimated, considering sex, age, and type of chest pain.1 Functional tests performed 3 months earlier were inconclusive: a stress electrocardiogram (ECG) showed ST-segment depressions at 100 W of −0.2 mV in lead I and −0.15 mV in V5, while stress magnetic resonance (MR) perfusion imaging had negative results. The patient had cardiovascular risk factors including arterial hypertension and a family history of CAD. With antihypertensive therapy, her blood pressure was 119/79 mm Hg. Blood lipids were as follows: total cholesterol, 167 mg/dL (abnormal >200 mg/dL); low-density lipoprotein cholesterol, 80 mg/dL (abnormal >100 mg/dL); high-density lipoprotein cholesterol, 55 mg/dL (abnormal <60 mg/dL); and triglycerides, 80 mg/dL (abnormal >150 mg/dL). To evaluate for CAD, she underwent coronary computed tomography (CT) angiography (Figure).

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    H Silverstein, MD | Preventive Medicine Center
    From the furnished information I would like to have known much more about the chest pain itself. If it were 20-30 minutes, unrelated to activities, for me, that would have ceased any further investigation. However, the patient may have been of a variety where further documentation was necessary for reassuance. With her low non-HDL cholesterol <90 wher CAD regression occurs, near perfect blood pressure and triglycerides without a classic anginal history, I would not have done the CT angiogram but would have considered reassurance, physical therapy, an upper GI X-ray, and possible psychological evaluation and support. Arm chairing is fraught with danger. I would not have done the CT angiogram at all as a best guess from this armchair. HRS, MD, FACC
    CONFLICT OF INTEREST: None Reported
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