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I read with interest the article on electron-beam computed tomography (EBCT) in the diagnosis of coronary artery disease (CAD) by Nallamothu et al.¹ I was particularly amused by the authors' concluding remark that "EBCT appears to be reasonably accurate at detecting obstructive CAD in patients undergoing coronary angiography, with sensitivity and specificity comparable to those reported for traditional exercise stress testing"¹ (italics mine). But the authors did not mention the relative costs of EBCT and traditional exercise stress testing; EBCT costs much more than the traditional exercise stress testing.

The recent American College of Cardiology/American Heart Association (ACC/AHA) expert consensus document on EBCT for the diagnosis and prognosis of CAD did not support the widespread clinical use of EBCT for the diagnosis and prognosis of CAD.² One reason for the lack of support for the use of EBCT has been related to a new standard for medical evidence that . . . [Full Text of this Article]

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Electron-Beam Computed Tomography in the Diagnosis of Coronary Artery Disease: A Meta-analysis
Brahmajee K. Nallamothu, Sanjay Saint, Lawrence F. Bielak, Seema S. Sonnad, Patricia A. Peyser, Melvyn Rubenfire, and A. Mark Fendrick
Arch Intern Med. 2001;161(6):833-838.
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