This case illustrates the severe downstream hazards and potential for iatrogenic harm associated with the inappropriate use of cardiac computed tomography angiography in low-risk patients.
May caution against inappropriate CCTA in low-risk patients; leaves open whether stricter criteria reduce iatrogenic harm.
A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotopic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain.
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Becker et al. (2010) studied this question.
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