To what extent would an angiogram be capable of picking up coronary atherosclerosis that would tend to go unnoticed by a nuclear stress test? Would an angiogram offer greater risks than a stress test? How great would that additional risk tend to be?
A nuclear stress test is about 85% accurate in finding CAD whereas a angiogram is 100% accurate. The angiogram also carries a 1 - 3% risk of complications, the most common risk, although very rare, is having an artery dissected during the procedure which results in emergency bypass surgery. Having said that, if I was told I needed one I would do it without hesitation. It is the gold standard of heart tests to determine if CAD is present. I have had 2 nuclear stress tests in the past three years that were normal so I never needed a cath, but would galdly do it if my cardiologist said it was necessary.
Another alternative that should be discussed is a 64 slice CT scan. I had three nuclear scans in three years prior to my successful ablation for a fib. All indicated good blood flow to the heart. I wanted a CT scan to rule out any artery disease as a contributor to my a fib, but my cardiologists told me it was not medically necessary. I finally convinced them that it was for my peace of mind even if they thought it was unnecessary, and I would pay for it. The scan, a very simple and quick procedure, suggested I was 40-70% blocked in two arteries. It was useful information and I am now adjusting my diet, exercise, and cholesterol meds to respond to that new found information.
As earlier stated, the angiogram is the gold standard--but with risks. The CT is very good, noninvasive, and has only the very slight risk associated with radiation.
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