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Is CT angiography better than routine coronary angiography?

Q: I am a doctor. My father has had two heart attacks after which he underwent angioplasty in descending LAD. After this a triple vessel disease was diagnosed, as there was 90% blockage at the bifurcation of LCA and he underwent bypass surgery. For the last few months he has been feeling slight heaviness and pain in the chest. He is 62 years old now. He is non hypertensive, non diabetic and non smoker. He has been advised angiography by one leading cardiologist and cardiac CT by another. Please advise, which is the best modality?

A:Both CT angio and routine coronary angiography have the same goal i.e. visualise the native arteries and the grafts. If the suspicion of disease requiring intervention is high then invasive angiography is preferred at present because angioplasty if indicated can be done in the same sitting and an angiogram will not have to be repeated. However if the clinical picture suggests a low probability of significant problem then it is reasonable to have CT angiography. Both the procedures involve injection of dye in any case. Usually an angiography by traditional method will be repeated if CT angio shows significant problem needing intervention.

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