Patients who have heart CT scans gain no advantage over other tests
SANDIEGO—Peoplechecked with a heart CTscan after seeing a doctor for chest pain have no less risk of heart attack, dying or being hospitalized months later than those who take a simple treadmill test or other older exam, finds a big federal study. ‘A bad reflection’
The results are a surprise: CT scans, fancy X-rays that give 3-D images of heart arteries, were expected to prove best and instead turned out to be just a reasonable alternative. Doctors have used these scans for a decade without knowing whether they are better than traditional tests. The federal government funded the $40 million study — the largest ever of heart imaging — to find out.
But the study also wound up exposing how much medical radiation most patients like this — 4 million in the United States each year — are getting. Radiation can raise the risk of developing cancer, yet few doctors are choosing heart tests that do not require radiation, the study revealed.
“It’s such a bad reflection on American medicine,” said one independent expert, Dr. Eric Topol of the Scripps Clinic in La Jolla, Calif. “Look at how much radiation they gave these poor people,” equivalent to 500 to 700 regular Xrays, he said. “That is despicable.”
If more patients were told the radiation dose before agreeing to a test, more would end up with safer alternatives, he said. 10,000 patients
The study involved more than 10,000 patients in the United States and Canada. Results were revealed Saturday at an American College of Cardiology conference in San Diego and published online by the New England Journal of Medicine.
Chest pain can stem from something as serious as a clogged artery or as harmless as indigestion. CT scans are widely used to diagnose heart problems in emergency rooms. But their value isn’t known for people who go to a doctor with new but stable, less severe symptoms suggesting hidden heart disease.
The aim of the study was to see which test led to the best diagnosis and treatment, thereby preventing the most deaths, heart attacks and hospitalizations for heart-related reasons over the next two years.
CT scans cost roughly $400; a treadmill test, $175; echocardiogram, $500 and nuclear imaging, $946 to $1,132. But a financial analysis found total costs, including follow-up testing, were about the same.