It’s not unusual for patients with symptoms like chest discomfort to have an abnormal nuclear stress test or CTA (Computed Tomographic Coronary Angiography) scan. What should you do to prevent symptoms and heart attacks in this setting?
It’s not clear if the balloon and stent procedure combined with medications or medical treatment alone is the best answer. The Courage Trial suggested that treatment with medication alone may be adequate for some. Who then should undergo invasive coronary angiography?
A recent study suggests that the combination of CTA and nuclear imaging may be the answer. Normal nuclear imaging indicates good blood flow to heart muscle and a good prognosis even in the setting of a blockage on CTA. The risks of an invasive procedure (death, heart attack, stroke, kidney damage, and radiation exposure) can often be avoided. Approximately 70% of the patients in this study avoided an unnecessary invasive procedure.
As mentioned above, nuclear imaging evaluates blood flow and the heart’s function. CTA, on the other hand, evaluates the anatomy of the coronary arteries. The combination of function and anatomy provides a complete assessment.
Each study makes up for the deficiencies of the other. CTA is less accurate in those with calcified arteries; nuclear imaging, on the other hand, is not affected by calcium. Alternatively, nuclear imaging can incorrectly label you with bad blood flow if breast tissue or your diaphragm obstructs the image; CTA does not have this issue.
In the next few years cameras will likely offer a combination of CTA and nuclear imaging in one test.