CT is a safe, comparable alternative to invasive coronary angiography for chest pain work-ups

For patients with stable chest pain and a probability of obstructive coronary artery disease, computed tomography is comparable to invasive coronary angiography when measuring risk for major cardiovascular events. 

That’s according to new research published in the New England Journal of Medicine that compared the adverse cardiovascular events for patients who received either CT or invasive coronary angiography (ICA) as their initial diagnostic imaging exam for chest pain workups. The study found that using CT as the initial imaging strategy resulted in fewer procedure-related complications without sacrificing prognostic value. 

This is a change from the reference standard of ICA for CAD diagnosis, which can cause rare but major complications for patients. Coronary CT angiography has found favor among physicians over the last several years due to its less invasive approach to assessing chest pain, and previous studies have observed the modality’s similar cardiovascular outcomes when compared to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography) and standard care. 

“CT has generated interest since it may rule out obstructive CAD in a noninvasive procedure with a low risk of adverse events as it identifies patients who are appropriate candidates for coronary revascularization,” wrote Marc Dewey, MD, with the department of radiology at Charité-Universitätsmedizin Berlin, and colleagues.