All the studies of MDCT included symptomatic patients from cardiologists or tertiary care centers in Europe and Israel, potentially lessening the technique’s generalizability to many clinical settings. Moreover, the availability of MDCT is limited, especially compared with stress echocardiogram and MPI.
MDCT requires a heart rate <60 to 70 beats per minute, which necessitates giving beta-blockers to patients with higher heart rates; not all patients can tolerate the medication or lower heart rate. MDCT also requires giving intravenous contrast media to visualize the coronary arteries and exposes the patient to a high level of radiation.
Notably, all studies of ETT, MPI, stress echocardiography, and MDCT enrolled symptomatic patients, limiting their evaluation as screening tools.
Recommendations
The American Heart Association recommends testing symptomatic women with a Framing-ham risk score of 10% or greater. A 2005 consensus statement allows providers to rely on local practices and available tests, with the caveat that ETT is the preferred initial test.7
The American College of Radiology expert consensus panel recommends the use of stress nuclear imaging and chest radiography to evaluate patients with chronic chest pain and suspected CAD; the recommendation does not specify testing method based on sex.8