I was 40 years old and found that I had cardiovascular stenosis. After doing coronary CTA, the doctor asked me to do angiography again? Is this a duplicate examination?

I heard a patient complain to the doctor in the outpatient clinic:

This is a 40-year-old man. During the physical examination, the electrocardiogram found "inverted T waves". The local hospital suspected "myocardial ischemia" and asked him to do a coronary CTA to see if there was any cardiovascular stenosis. The test results showed: moderate coronary artery stenosis. The doctor also recommended hospitalization for cardiac angiography to see if a stent was needed.

The patient was a little hesitant, but he still did it. The angiography showed that the main blood vessels were 60% narrowed. The doctor said that it could be treated with medication.

The patient felt more and more aggrieved: " Why do I need to do angiography after the coronary CTA? They are both used to check whether there is any stenosis in the cardiovascular system. The hospital asked me to do it but did not put a stent in it. Isn't this a duplicate examination? " So he went to a higher-level hospital to get clarification.

The doctor decides whether to do cardiac angiography after coronary CTA:

1. Which patients should undergo coronary CTA first?

Cardiac angiography is traumatic, expensive, and requires hospitalization, so doctors recommend that only patients with typical symptoms and a high degree of suspicion undergo cardiac angiography directly.

For patients whose symptoms are not typical, cardiac angiography is a bit of an overkill. Coronary CTA is simple, cheap, and does not require hospitalization. It is more suitable for screening such patients and then angiography after stenosis is found.

2. Which patients need to undergo cardiac angiography?

1. When coronary CTA shows no stenosis, coronary heart disease can be excluded;

2. When the result shows mild stenosis, the lesion is mild and will not cause angina symptoms, so cardiac angiography is not required;

3. When the results show moderate or severe stenosis, due to the accuracy of coronary CTA, the actual degree of stenosis fluctuates greatly. The angiography result may be 50% stenosis or greater than 75%, and the treatment methods are also completely different. The former chooses drug treatment, while the latter will cause myocardial ischemia and requires cardiac angiography to guide stent implantation.

3. Can electrocardiogram replace these tests?

Many friends are often accused of having heart disease because of “abnormal” electrocardiograms. Is this reliable?

Not reliable!

Compared with the nearly 100% accuracy of cardiac angiography, the accuracy of electrocardiogram is less than 50%, and meaningful waveform changes may only occur when symptoms occur. In addition, normal people may also have "abnormal" electrocardiograms, which have nothing to do with cardiovascular stenosis.

Therefore, except for special circumstances such as acute myocardial infarction, professional doctors will not diagnose coronary heart disease based on only one electrocardiogram, and they cannot use an electrocardiogram to replace cardiac angiography or coronary CTA.

I am Dr. Zhang from the Department of Cardiology. If you like my popular science articles, please like them! You can also share them with friends in need! Follow me to see more health knowledge about heart disease!