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BMJ 2008; 337 doi: (Published 02 December 2008) Cite this as: BMJ 2008;337:a2802

CT angiography “just another pretty picture”

Computed tomographic (CT) angiography is a good diagnostic test for coronary obstruction in people with chest pain, but not good enough to replace traditional coronary angiography, according to a recent international study. After comparing both tests in 291 adults, the authors concluded that although CT angiography looked accurate overall (area under the receiver operating characteristic curve 0.93, 95% CI 0.90 to 0.96), the newer test was let down by a negative predictive value of 83% (75% to 89%) and a positive predictive value of 91% (86% to 95%). It misclassified 13% of all patients compared with conventional angiography.

If CT angiography can’t be relied on to rule in or rule out a clinically relevant obstruction, what exactly is it for ask two experts from the US (p 2309). The explosive growth in the use of this and other new technologies is rapidly bankrupting Medicare and Medicaid services because the public purse reimburses hospitals for tests of questionable value, including CT angiography. CT angiography gives patients a higher dose of radiation than conventional angiography, and there is no indication from this or any other study that the additional risks are offset by better outcomes, such as fewer heart attacks The authors write that “without such evidence, a high resolution cardiac CT angiographic image of the heart is just another pretty picture.”

Survival still poor for patients with ventricular assist devices

Ventricular assist devices are a treatment of last resort for people with end stage heart failure. They can be temporary or permanent, and trials suggest that they can prolong survival for some patients. Overall mortality remains high, however. A retrospective look at Medicare claims data from the US shows that fewer than half the patients given a device between 2000 and 2006 were still alive a year later. Survival was better for patients given a device as primary treatment for …

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