The 2012 American College of Cardiology/American Heart Association Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease recommends that the use of coronary computed tomography angiography (CCTA) is reasonable for patients with a low to intermediate pretest probability of stable ischemic heart disease who are not able to exercise (Class IIa, level of evidence: B) and might be reasonable for patients able to exercise (Class IIb, level of evidence: B).1 In 2016, the National Institute for Health and Care Excellence in the United Kingdom endorsed CCTA as the test of first choice for all patients without established coronary artery disease who present with chest pain.2 Consequently, advocates of CCTA have argued for the American College of Cardiology/American Heart Association guidelines to be updated in alignment with the National Institute for Health and Care Excellence recommendations.3 Is the strength of evidence sufficient to justify these recommendations?
Kaul S. Evaluating the Evidence for Coronary Computed Tomography Angiography as the Noninvasive Test of Choice for Patients With Stable Chest Pain. JAMA Cardiol. Published online December 26, 2018. doi:10.1001/jamacardio.2018.4332
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