Coronary CT Scans Make the Cut

On comfort, speed, and safety, the high-tech cardiac test beats the alternative, an invasive angiogram.


A 3-D CT scan shows a healthy heart.

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People with sudden chest pain often end up in the ER, where doctors need to determine if their arteries are clogged—and a heart attack imminent—or if they're in the clear. For some such patients, cardiac CT scans can answer the question with less pain and a lower risk of complications than the alternative. And thanks to the Centers for Medicare and Medicaid Services, which was going to limit coverage for the test but changed its mind in March, many patients will continue to have access to the noninvasive scans.

CT angiography, as it's called, produces high-resolution 3-D images enabling doctors to quickly detect blockages or narrowing of the arteries. They can then decide if a patient needs further examination and treatment with a catheter angiogram, angioplasty, or bypass surgery, according to Douglas Weaver, president-elect of the American College of Cardiology.

Two large, recent trials have found that CT angiography is as accurate at detecting coronary artery disease as conventional, invasive catheter angiograms. It can identify the 25 to 30 percent of patients who could be spared from invasive tests, says Scott Flamm, head of cardiovascular imaging at the Cleveland Clinic.