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In their article, Nallamothu et al¹ conclude that, "The performance of EBCT as a diagnostic test for obstructive CAD is reasonable based on sensitivity and specificity rates." Unfortunately, the most common indication for EBCT currently in our market is the screening of asymptomatic adults, often driven by newspaper and billboard advertisements. It would have been helpful for the authors to discuss the implications of their data for such widespread screening of low-risk populations with EBCT. To be specific, if the diagnostic threshold is set to define a sensitivity of 92% and a specificity of 51%, consistent with the studies they summarize, and if the test is applied to a cohort of 1000 asymptomatic adults with a true CAD prevalence of 5% (close to the overall prevalence at age 50 years), the positive predictive power of EBCT will then be only 8.7%. If the sensitivity is reduced to 80%, and the . . . [Full Text of this Article]

RELATED LETTER

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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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.
ABSTRACT | FULL TEXT