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Long term prognostic value for a normal CCTA

      The 2021 multi-society guideline for the evaluation and diagnosis of chest pain was designed to be used by all clinicians evaluating patients in the emergency department (ED) and outpatient setting. It also recommended personalized testing based on the patients’ symptom and risk profile, which favored anatomic imaging for screening, including coronary artery calcium (CAC) for low-risk patients, and coronary computed tomographic angiography (CCTA) for intermediate risk.
      • Gulati M.
      • Levy P.D.
      • Mukherjee D.
      • et al.
      AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines.
      However, the guideline suggested a two-year warranty period for CCTA, which underestimates the long-term prognostic value of a normal cardiac CT. This recommendation may lead to more repeat testing than is clinically necessary and a waste of resources. In this letter, we attempt to explore the robust evidence available for outcomes in patients with stable and acute chest pain who have a “normal” CCTA, which is defined as an angiographically normal vessel without any stenosis or atherosclerotic plaque.
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