What is it about?

A letter to the editor raises concerns about a study that compared exercise treadmill testing to exercise myocardial perfusion imaging in women with suspected coronary artery disease. The letter points out the study's low power, the use of medical tests as a surrogate for clinical management changes, and questions whether either test is useful in low-risk symptomatic women.

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Why is it important?

This letter highlights important limitations of a study comparing diagnostic tests for women with suspected coronary artery disease. It raises crucial questions about the study's power, the use of surrogate variables, and the clinical utility of the tests in low-risk patients. These concerns are relevant for interpreting the study's results and their application to patient care.


I find the points raised in this letter compelling and believe they warrant serious consideration. The study's low power is a major limitation that makes it difficult to draw firm conclusions. Additionally, the use of medical tests as a surrogate for clinical management changes is problematic, as it fails to capture the true impact on patient outcomes. Finally, I agree that it is important to consider whether these tests are necessary for low-risk symptomatic women, or if risk factor reduction alone might be sufficient. These issues highlight the need for well-designed studies with adequate power and clinically relevant outcomes to guide optimal test selection for our patients.

Thomas F Heston MD
University of Washington

Read the Original

This page is a summary of: Letter by Heston Regarding Article, “Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the..., Circulation, May 2012, Wolters Kluwer Health,
DOI: 10.1161/circulationaha.111.069286.
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