Impact of coronary CT angiography on a low-risk cohort

January 01, 0001

Impact of coronary CT angiography on a low-risk cohort

These US and South Korean investigators studied asymptomatic patients from a health-screening program. The study population comprised 1000 patients who underwent coronary computed tomographic angiography (CCTA) as part of a prior study and a matched control group of 1000 patients who did not. They assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months.

They found: "A total of 215 patients in the CCTA group had coronary atherosclerosis (CCTA positive). Medication use was increased in the CCTA- positive group compared with both the CCTA-negative (no atherosclerosis) and control groups at 90 days (statin use, 34% vs 5% vs 8%, respectively; aspirin use, 40% vs 5% vs 8%, respectively), and 18 months (statin use, 20% vs 3% vs 6%, respectively; aspirin use, 26% vs 3% vs 6%, respectively). After multivariable risk adjustment, the odds ratios for statin and aspirin use in the CCTA-positive group at 18 months were 3.3 and 4.2, respectively. At 90 days, in the total CCTA group vs controls, there were more secondary tests (55 {5%} vs 22 {2%}) and revascularizations (13 {1%} vs 1 {0.1%}). One cardiovascular event occurred in each group over 18 months."

The authors concluded: "An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA should not be considered a justifiable test at this time."

CCTA is of unproven benefit for screening a low-risk population even when it does lead to increased use of pharmacotherapy as prevention of cardiovascular events.

For the full abstract, click here.

Arch Intern Med 171(14):1260-1268, 25 July 2011 © 2011 to the American Medical Association
Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population. John W. McEvoy, Michael J. Blaha, Khurram Nasir, et al. Correspondence to Dr. Hyuk-Jae Chang: [email protected]

Category: K. Circulatory. Keywords: coronary computed tomographic angiography, CCTA, prevention, statin, aspirin, cardiovascular events, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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