In Reply There are many more patients with incidental coronary artery disease (CAD) than with ischemic heart disease. Incidental CAD is defined as disease detected by coronary computed tomography angiography (CCTA) that would not be detected with functional stress testing alone. As proof of concept, among asymptomatic adults averaging 75 years of age without a diagnosis of heart disease, the prevalence of incidental, high-grade CAD is 41% based on CCTA, and nearly all have some evidence of atherosclerosis.1 This large pool of incidental CAD in the population exposes individuals to overdiagnosis from CCTA.
Schmidt T, Maag R, Foy AJ. Enhanced Education for Noninvasive Cardiac Testing—Reply. JAMA Intern Med. 2017;177(5):746–747. doi:10.1001/jamainternmed.2017.0771
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