Coronary CTA vs Functional Stress - Which Is Better?

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There was no mortality difference based on which stress test was done, coronary CTA (CCTA) or functional stress testing.  But CCTA led to more downstream testing.  Either test is fine, but know that tests may have unintended consequences.

Why does this matter?
There is debate over stress testing from the ED.  Is it beneficial? If so, for whom?  CCTA gives an anatomic image of the vessels, and prior studies have shown that stress tests generally lead to more downstream invasive testing.  But does this change what matters - saving lives by allowing earlier intervention?

CCTA vs Functional Stress Tests
This was a systematic review of 13 trials, with a pooled number of about 10,000 patients who received CCTA or about 10,000 with functional stress testing.  They found that there was no difference in mortality or hospitalization between the groups.  CCTA patients had a lower incidence of MI in those with stable but not acute chest pain.  Those with CCTA were more likely to have subsequent cardiac cath, diagnosis of CAD, and initiate treatment with aspirin and statins.

Source
Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis.  JAMA Intern Med. 2017 Oct 2. doi: 10.1001/jamainternmed.2017.4772. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD

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