{"id":8380,"date":"2011-05-23T17:24:46","date_gmt":"2011-05-23T21:24:46","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=8380"},"modified":"2011-07-19T17:44:24","modified_gmt":"2011-07-19T21:44:24","slug":"what-is-the-impact-of-screening-low-risk-patients-with-ct-angiography","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/05\/23\/what-is-the-impact-of-screening-low-risk-patients-with-ct-angiography\/","title":{"rendered":"What Is the Impact of Screening Low-Risk Patients with CT Angiography?"},"content":{"rendered":"<p>In <a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/archinternmed.2011.204\">a study published online in <em>Archives of Internal Medicine<\/em>,<\/a> John McEvoy and colleagues examine the impact of screening low-risk patients with coronary CT angiography (CCTA). They compared 1000 South Korean patients who underwent CCTA with 1000 matched controls.<\/p>\n<p>CCTA identified 215 people with coronary atherosclerosis. At 90 days and at 18 months, statins and aspirin were being taken by a significantly higher percentage of patients in the CCTA-positive group than in the CCTA-negative group or in the matched control group:<\/p>\n<p>At 90 days<\/p>\n<ul>\n<li>statins were used in 34% of CCTA-positive patients vs. 5% of CCTA-negative patients and 8% of those in the control group<\/li>\n<li>aspirin was used in 40% vs. 5% and 8%<\/li>\n<\/ul>\n<p>At 18 months<\/p>\n<ul>\n<li>statins were used in 20% vs. 3% and 6%<\/li>\n<li>aspirin was used in 26% vs. 3% and 6%<\/li>\n<\/ul>\n<p>The investigators also found that, at 90 days, there were more secondary tests and revascularizations in the CCTA group than in the control group:<\/p>\n<ul>\n<li>secondary tests: 5% vs. 2%, p&lt;0.001<\/li>\n<li>revascularizations: 1% vs. 0.1%, p&lt;0.001<\/li>\n<\/ul>\n<p>At 18 months there was one cardiovascular event in each group.<\/p>\n<p>The authors observed that in their study &#8220;we found that the evidence-free performance of CCTA in asymptomatic patients was associated with further evidence-free testing and interventions.&#8221; They concluded that their data &#8220;concurs with the prevailing notion that screening CCTA does not have a role in low-risk patients.&#8221;<\/p>\n<p>In <a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/archinternmed.2011.205v1\">an invited commentary<\/a>, Michael Lauer said the study &#8220;serves as a powerful reminder of the 2-edged effects of screening.&#8221; He continues:<\/p>\n<p style=\"padding-left: 30px;\">&#8220;The only way to know whether screening by CCTA leads to clinically beneficial diagnosis of real disease, as opposed to pseudodisease, is by performing large-scale controlled trials, preferably with randomization. We cannot simply assume that just because a screening test predicts clinical outcomes, interventions necessarily will prevent them. Similarly, we cannot assume that because other tests diagnose disease that responds to treatment, a new screening test must do the same.&#8221;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In a study published online in Archives of Internal Medicine, John McEvoy and colleagues examine the impact of screening low-risk patients with coronary CT angiography (CCTA). They compared 1000 South Korean patients who underwent CCTA with 1000 matched controls. CCTA identified 215 people with coronary atherosclerosis. At 90 days and at 18 months, statins and [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,1],"tags":[503,664],"class_list":["post-8380","post","type-post","status-publish","format-standard","hentry","category-cardiac-imaging","category-general","tag-ct-angiography","tag-screening"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8380","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=8380"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8380\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=8380"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=8380"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=8380"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}