Aditya A Joshi Profile picture
Advanced HF Cardiologist in making @UWCardiology. Son, Husband to @AvanteeG, Dad, Physician. @FCBarcelona. Opinions own.

Sep 26, 2020, 12 tweets

Now the second debate! Dr Newby on debating that CT is the first line in stable chest pain!

He starts by disclosures and states what the patient may care about and that is what he will talk about.

He debates that his opponent has published a paper suggesting specificity for CT is almost >90%

ESC guidelines have also adopted this!

What about risk prediction? Death or no fatal MI is predicted well with CT. Normal CTA also has a great negative predictive value!! Even non-obs disease on CTA suggests risk prediction.

CT better over ischemia testing in future risk prediction!

Another paper from his opponent showing limitation of ischemia testing. Also CT gives information about actionalbe disease!

Thus CT has more specificity and negative predictive value and get more data on actionable disease! CTA also prevents down streat caths and decreases cost and provides for better targeted revasc.

No difference in relief of angina based on whether patients underwent CT or ischemia testing. Further, reduction in subsequent MI based on patients who underwent CT. SO CT WINS!

That is it from Dr Newby. Now on is Dr Bateman! #ASNC2020

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