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June 3, 2020

Does Every Patient With Stable Chest Pain Need Coronary Computed Tomography Angiography, Usually After a Standard Stress Electrocardiogram?

Author Affiliations
  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Cardiol. 2020;5(8):862-863. doi:10.1001/jamacardio.2020.1579

The Scottish Computed Tomography of the Heart (SCOT-HEART) trial1-3 used coronary computed tomographic angiography (CTA), usually (85% of the time) as a second test after an initial stress electrocardiogram (ECG) in a large, pragmatic randomized trial in Scotland. Cardiovascular deaths and nonfatal myocardial infarctions were reduced by 41% after 5 years in the patients randomized to CTA.2 In 3 major articles,1-3 the investigators have reported and explained the results of SCOT-HEART to justify the use of CTA as a second test. Their results are discordant with a large North American trial4 that examined the value of CTA as a first test, in place of stress testing. If the answer to the question posed in the title of this article is yes for other populations, the implications for clinical practice are substantial. This Viewpoint summarizes my arguments for answering this question with a no and concluding that the SCOT-HEART results are not generalizable to patient cohorts in other countries.

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