Perspective:

This study finds that while CCTA generally results in lower hospital costs and reduced length of stay, these patients also have increased rates of invasive angiography and revascularization. As the authors acknowledge, it is unclear whether these findings represent overutilization of invasive angiography and revascularization following CCTA, or underutilization following usual care; nevertheless, the burden of proof is on CCTA to demonstrate that this is not a result of overutilization compared to standard care. Further, short-term findings may not reflect long-term outcomes, costs, and resource utilization, and additional studies are needed to address these questions. But perhaps most importantly, overall event rates were low in these populations, suggesting that many of these patients may not need additional testing at all, and may be better suited for outpatient follow-up, rather than protocols that rely on automated imaging tests.