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Coronary CT angiography should be used to screen for coronary heart blockages in patients who have no signs or symptoms suggestive of coronary artery disease

Neither Coronary CT angiography nor coronary MRI should be used to screen for coronary heart blockages in patients who have no signs or symptoms suggestive of coronary artery disease, said Dr KK Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute while delivering a lecture in a cardiology workshop organized by Delhi Chapter of Indian Institute of Homeopathic Physicians at Moti Bagh here today.

Based on the recommendations from the 2008 American Heart Association, Dr Aggaral further narrated that

• Noninvasive coronary angiography is reasonable for symptomatic patients who are at intermediate risk for coronary artery disease after initial risk stratification, including patients with equivocal stress test results. Diagnostic accuracy favors Coronary CT angiography over coronary MRI for these patients.

• Coronary CT angiography is NOT recommended in patients with either a very low pretest likelihood of coronary stenosis or a high pretest likelihood of coronary stenosis.

• Concerns about radiation exposure limit the use of Coronary CT angiography in patients with very low likelihood of coronary disease. Patients with high likelihood of coronary artery disease are likely to require invasive coronary angiography and intervention.

• The usefulness of Coronary CT angiography is reduced in patients with pronounced coronary calcification.

• Coronary MRI or Coronary CT angiography is suggested to evaluate suspected or known congenital or acquired coronary anomalies, particularly to establish the proximal course relative to the great vessels of coronary arteries with abnormal origin.

• Coronary MRI is preferred in these younger patients to avoid radiation exposure and in patients with contraindications to iodinated contrast or beta blockers.

Source: American Heart Association