Should I get a CT scan for coronary artery disease?

feelinggood — Wed, 13 Aug 2008 12:54:00 -0800

Should I get a CT scan for coronary artery disease or atherosclerosis? My cardiologist wants me to have a CT scan , but after reading this, this, and an article in Consumer Reports on Health March 2007 entitled "Angioplasty: Resist the rush", I am skeptical. BACKGROUND
Note: I live in Toronto (Canada) so neither cost nor a private health plan is an issue here. [Doctor or clinic profit may be.]

I am a 63-year-old male in good health, 5' 7" and 190 lbs, with a 36" waist.
January 2007: routine ECG showed a 3 mm depression in the ST segment. I had no symptoms.
March 2007: blood tests, an echocardiogram, and a perfusion MRI stress test showed that I had "a 70% chance of a 70% blockage" in the left anterior descending artery (LAD). During the stress test I felt a tightness in my chest, as if my rib cage was not big enough for my lungs.
The cardiologist recommended an angiogram and probably a stent. I refused and opted for treatment by exercise and diet.
May 2008: the above tests repeated. Now only a 1.5 mm depression in the ST segment. No symptoms except the tightness during the stress test.

The CT scan seems to me inadvisable for two reasons: 1) it can't tell whether my plaque is going to dislodge or not; and 2) it's the equivalent of about 400 chest x-rays.

Preliminary question: do I have angina (variously described on the internet as ranging from "severe chest pain" to "discomfort")? No one will give me an unequivocal face-to-face answer.

Big question: Should I have the CT scan?

The big a-ha! : I'm afraid to tell the cardiologist I don't want the scan. After all, he's the expert and I read only the NY Times, Life and Consumer Reports; it doesn't seem to be a fair match. Also, I have a feeling that no other cardiologist out there would disagree with him.

(Can anyone recommend a non-invasive, non-interventionist, evidence-based-medicine cardiologist in the GTA?)

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Should I get a CT scan for coronary artery disease?