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Compounding uncertainties with first-line computed tomography coronary angiography
  1. Paul C Cremer
  1. Correspondence to Dr Paul C Cremer, Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA; cremerp{at}ccf.org

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Every year, hundreds of thousands of stable patients with chest pain are evaluated at rapid access clinics in England and in various other settings throughout the UK. The majority of these patients are at low risk for short-term adverse cardiovascular events, though to decrease lifetime risk, attention to proven preventative therapies is of paramount importance. Oftentimes, however, the primary focus is on near-term diagnostic testing, and the low yield of this testing has contributed to increasing healthcare costs and misallocation of resources.1 More recently, the National Institute for Health and Care Excellence (NICE) recommended CT coronary angiography (CTCA) as a first-line test, a dramatic departure from previous guidelines, centred on controversial interpretations of CTCA clinical trials.2

In the Heart paper by, Dreisbach et al, further the controversy by providing valuable insights into the challenges in implementing CTCA as a first-line test, specifically emphasising deficiencies in trained personnel and capable equipment.3 By their estimates, approximately 42 000 CTCAs are performed annually in the UK with an expected increase to 350 000. Even though the magnitude of this increase is alarming, the geographic variation in available resources is also striking. Throughout the UK, there are only 29 …

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