Anatomical versus functional testing for coronary artery disease

In English nursery rhyme, it is traditional for a Duke to have 10 000 men. NEJM has published a trial from Duke University that recruited 10 000 men and women, and allowed in a further three for extra measure. These 10 003 recruits were those “whose physicians believed that nonurgent, noninvasive cardiovascular testing was necessary for the evaluation of suspected coronary artery disease.” That is a fate which befalls a staggering four million Americans every year. These people were randomised to be investigated either by coronary computed tomographic angiography or functional testing, which in almost every case meant exercise ECG. I struggled a little with some of the figures, but I broadly agree with the conclusion: “In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of two years.” But I do just wonder how many of these people really “required” testing in the first place. Oh, the PROMISE trial of Duke, It had 10 000 men; They marched them up on a treadmill test, Or they scanned their arteries then. And when they were clear, they were glad, And when they were blocked, they were down, And when they were only halfway blocked, They were neither glad nor down. Nobody knows the meaning of the original nursery rhyme, and I’m not sure I know the meaning of this trial either...
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums