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Computed tomography angiography (CTA) can be used to rule out substantial obstructive coronary artery disease (CAD), but can it be used in lieu of invasive coronary angiography (ICA) in patients with atypical angina who are referred for ICA? This single-center study from Germany included 340 patients with atypical chest pain, defined as having either one or two of the following three features: retrosternal chest discomfort; precipitation by exertion; relief within 30 seconds to 10 minutes by rest or nitroglycerine. Patients were randomized to CTA (followed by ICA if positive for obstructive disease) or directly to ICA.
The primary outcome of major procedural complications (e.g., stroke, myocardial infarction) within 48 hours of the last angi…