Skip Navigation


European Heart Journal Advance Access originally published online on January 8, 2008
European Heart Journal 2008 29(5):680; doi:10.1093/eurheartj/ehm615
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/5/680    most recent
ehm615v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Klepzig, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Klepzig, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease

Harald Klepzig

Director of Cardiology & Pneumology
Klinikum Offenbach
Starkenburgring 66
D-63069 Offenbach
Germany

I read the article by Leber et al.1 with great interest. However, in my opinion, the clinical implications presented are unacceptable. The proposed sequence of procedures (CT scan, followed in some cases by non-invasive stress test to verify ischaemia, followed by cardiac catheterization) causes unnecessary exposure to radiation, risks of complications, costs and contradicts current ESC, and national guidelines on diagnosis and treatment of angina pectoris and PCI (http://www.escardio.org/knowledge/guidelines/, http://leitlinien.dgk.org/images/pdf/leitlinien_volltext/2003-03_koronare_herzerkrankung.pdf). The knowledge of coronary anatomy is mainly required in high-risk situations where special therapeutic options as coronary bypass operation or—in selected cases—PCI may serve to improve survival or limiting symptoms despite medical therapy.

Thus, evidence of ischaemia prior to cardiac catheterization is an integral part of quality assurance programmes in Germany in order to detect clinical centres with unnecessary coronary investigations. At present, introducing CT scans after an initial superficial examination of the patient is a paradigm shift without scientific evidence for its benefit, but with the potential of misleading patients, exploding costs and damaging our reputation.

Reference

  1. Leber, et al. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J (2007) 28:2354–2360.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/5/680    most recent
ehm615v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Klepzig, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Klepzig, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?