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…

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A new study raises the possibility that the radiation dose for MPI SPECT imaging can be reduced by half without sacrificing image quality, according to Dr. Nili Zafrir, who presented the results of the study this week at the International Conference of Non-Invasive Cardiovascular Imaging in Amsterdam. Recently, software has become available that can reduce…

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Could the real curse of the mummy be coronary artery disease? Despite strict adherence to the original Mediterranean diet and a complete lack of tobacco, trans fats, and refined sugars, an Egyptian princess who died around 1550 BC is the first person in history to receive a diagnosis of coronary artery disease. A CT scan…

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The PROSPECT trial provides some interesting insights about the mechanisms of thrombotic coronary artery disease, but how, if at all, should it change practice? Here are what the findings do and do not demonstrate: What the PROSPECT study says: In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a median follow-up of 3.4 years were…

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In this journal club, I compare the published data from an original trial with the authors’ conclusions in a substudy from that trial. Often, a substudy provides valuable insights that complement the initial trial findings. Sometimes, however, you need to look closely to identify the additional insight. Case in point: COURAGE. The Original COURAGE Trial…

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A 52-year old woman with atypical chest pain ended up with a heart transplant after a CT angiogram to “reassure” her sparked a devastating sequence of events. Following a false-positive CT angiogram, the patient underwent coronary angiography and suffered a dissection of the left main coronary artery, followed by emergency CABG, subsequent graft failure, and…

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Editors’ Note: This text has been modified from its original form. Key elements of the case represent a composite of people and events. On a bright Saturday morning, I was the fellow on duty in the chest pain center. That meant I was responsible for evaluating and stress-testing patients who had been admitted from the…

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An alphabet soup of medical organizations (ACCF, SCCT, ACR, AHA, ASE, etc.) have updated their appropriate use criteria for cardiac CT. The lengthy document includes an evaluation of 93 clinical scenarios and finds that cardiac CT is appropriate in 38% of them. Use of cardiac CT in the rest of the scenarios is deemed inappropriate…

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A gene expression test can improve the prediction of CAD but may not be clinically useful, according to results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) study published in the Annals of Internal Medicine. The PREDICT investigators, led by Eric Topol, evaluated a gene expression test based on 23 genes…

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Arterial closure devices (ACDs) “have the potential to improve patient comfort,” but the current evidence isn’t sufficient to support routine use after cardiac catheterization, according to a scientific statement from the AHA published in Circulation. Led by Manesh Patel, the committee analyzed the data and concluded that although it is “reasonable” to consider using an…

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