Don't Stress Over Intermediate-Risk Chest Pain

Background: Patients with chest pain at intermediate risk for coronary artery disease (CAD) warrant additional noninvasive testing. Updated guidelines recommend either functional stress testing or coronary CT angiography (CCTA). Nonobstructive CAD may give rise to two-thirds of future myocardial infarctions but is not reliably detected with functional testing. Sensitivity for stress testing with SPECT is 73%. Global hypoperfusion due to balanced ischemia in the setting of multivessel disease may lead to false negative results. Design: Brief review of indications for CCTA. Discussion: CCTA offers improved prognostic value with a sensitivity and specificity of 91% for detecting significant coronary stenosis. It can also detect or rule out nonobstructive disease leading to more appropriate preventive therapy. Patients with no plaque or disease detected on CCTA have a 2-year low-risk future for major adverse cardiovascular events. CCTA is preferable to functional testing in patients aged more...