The clinical role of 'non-invasive' coronary angiography by multidetector spiral computed tomography: yet to be defined.

This editorial refers to ‘Detection of coronary artery stenoses using multidetector CT with 16×0.75 collimation and 370 ms rotation’† by S. Achenbach et al. , on page 1978 and ‘Limited diagnostic yield of non-invasive coronary angiography by 16-slice multidetector spiral computed tomography in routine patients referred for evaluation of coronary artery disease’‡ by C. Kaiser et al. , on page 1987 ‘Medicine is a science of uncertainty and an art of probability’ Sir William Osler (1849–1919) Seeing is believing. The great attraction of coronary angiography for both patient and doctor is the direct view of those small structures whose integrity may dictate life or death. In patients with suspected coronary artery disease (CAD), myocardial perfusion imaging or stress echocardiography may provide good and clinically meaningful distinction between those who are at risk and those who are not, but a shade of doubt remains. For those who find such doubts unacceptable, yet fear the small but definite risks of invasive coronary angiography, multislice spiral computed tomography coronary angiography (CTCA) comes as a deus ex machina —ready to solve all problems. The promise of cardiac CT is no less than the best of all worlds: high-resolution coronary images are able to give a definite answer beyond all doubts, yet avoiding unpleasant groin haematomas and the threatening atmosphere of a hospital. However, are these expectations justified? Two seemingly contradictory answers to this question are offered by Achenbach et al. 1 and Kaiser et al. 2 Although Achenbach et al. 1 demonstrate a high diagnostic accuracy of the technique and recommend CTCA for limited clinical application, Kaiser et al. 2 find both sensitivity and specificity of multislice CT unacceptably low for applying CTCA in daily clinical life. To put these statements into perspective, one needs to have a closer look at the patient populations in the two studies, details … *Corresponding author. Tel: +49 711 8101 3456; fax: +49 711 8101 3795. E-mail address : udo.sechtem{at}rbk.de