In a separate interview, Dr. James G. Adams, professor and chair of emergency medicine at Northwestern University in Chicago, said that no test is perfect, that all the evidence shows that coronary CT is at least as good as other testing strategies used in the initial evaluation of patients with acute chest pain, and that there are fewer hospital admissions.
"This [study] will certainly be used to promote coronary CT for patients at low to moderate risk of coronary disease," he said. "I believe that emergency physicians will increase their use."
Adoption of the CCTA approach depends on much more than whether emergency physicians find the results convincing, emergency physician Dr. Robert Solomon of Allegheny General Hospital in Pittsburgh said in an interview.
"Cardiology and radiology must also buy into it, and the resources necessary to enable clinicians to use this approach must be made available," he said. "This includes cardiologists, radiologists, and trained technologists. The necessary resources will not be available 24-7, even at tertiary care centers, so timing will always be an issue."
This study was sponsored by the Commonwealth of Pennsylvania Department of Health and the American Radiology Imaging Network Foundation. Dr. Litt reported grant funding and travel reimbursement from Siemens Medical Solutions and consulting fees from Medrad-Bayer. The study was simultaneously published online in the New England Journal of Medicine (2012 March 26 [doi:10.1056/NEJMoa1201163]).