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REPLY
Tests for Coronary Artery Disease
Alan M. Garber, MD, and
Neil A. Solomon, MD
21 December 1999 | Volume 131 Issue 12 | Page 980
IN RESPONSE:
Our study grew from an effort to compare commonly used noninvasive tests and a less commonly used, but highly accurate, alternative (positron emission tomography). We did not include electron-beam computed tomography (CT) in the comparison because it was not a widely accepted diagnostic test for coronary disease. The analysis considered stress echocardiography but not intravascular ultrasonography, which is usually performed as part of cardiac catheterization. To compare electron-beam CT with the other tests, the accuracy of electron-beam CT must be estimated from a pooled analysis of available studies, using inclusion and exclusion criteria such as those we used for the other noninvasive tests. Judging accuracy from a single study could be highly misleading because the published accuracy figures for electron-beam CT vary widely. Thus, we believe that it would be inappropriate to draw conclusions about the cost-effectiveness of electron-beam CT without conducting the pooled analysis. However, the growing number of studies assessing the accuracy of electron-beam CT in the diagnosis of coronary disease makes the comparison that Drs. Broemeling and Mielke suggest both timely and relevant.
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Author and Article Information
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 Author & Article Info
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Veterans Affairs Palo Alto Health Care System; Stanford University; Stanford, CA 94305 (Garber)
Kaiser Permanente; Oakland, CA 94612 (Solomon)
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[ABSTRACT][Full Text]
