Home HOW DO CCTA AND CONVENTIONAL AN ANGIOGRAM COMPARE?
For those at risk of coronary artery disease (CAD), screening exams are very important. CAD occurs when plaque (composed of fat, cholesterol, or calcium) builds up inside the arteries around the heart – too much plaque narrows the arteries and reduces blood flow. Screening tests help determine the amount of plaque, its nature (hard or soft), and what treatment options are applicable.
To help diagnose CAD, patients are usually referred for one of two main screening exams: a coronary angiography or a coronary computed tomography angiography (CCTA). Often, there is debate over which test is more accurate and safer.
Coronary angiography is the most common method for detecting coronary artery stenosis or narrowing of an artery that may require a stent or bypass surgery. In these cases, it can be used for both diagnosis and treatment in a single session, since the images are finely detailed and precise. This procedure is most often recommended for patients with a high risk of coronary artery disease and typical symptoms.
CCTA is quick, precise, and relatively painless with results that are detailed enough for doctors to make decisions that are 95-99% accurate in patients without severe disease. It’s able to reliably rule out coronary artery disease in patients with atypical symptoms and low-to-medium risk of disease, reducing the need for invasive angiography and rendering it a safe and effective tool when it is needed. It also requires very little preparation and no recovery time.
A coronary angiography is an invasive procedure, which in rare cases can lead to serious problems like heart attack or stroke. There is also a risk of a tear or sudden closure in an artery, allergic reaction to the dye, and bleeding or bruising where the catheter was inserted. It also requires fasting before the procedure and hours of hospitalized recuperation afterward. Plus, there is potential for overuse when diagnosing patients with atypical symptoms and low-to-medium risk of disease.
CCTA also has the possibility of an allergic reaction to the contrast dye. As well, certain patients may not be good candidates for this exam, such as:
There is ongoing debate over when to use CCTA versus coronary angiography and for which types of patients. Some recent studies have shown that the diagnostic abilities of the two exams are equivalent, but due to lower costs and improved safety CCTA is thought to be a better gatekeeper and first-line test to triage patients and determine the need for medical therapy or invasive evaluation. Plus, the current CT scanners have lower doses of radiation and improved accuracy as compared to older machinery, and patients often prefer CCTA for coronary disease testing since it’s less invasive.
Coronary CT angiography is available as a private pay exam, not covered by Alberta Health Care, at our Mayfair Place location. It can be purchased on its own or as part of a Health Assessment package, which provides a discount on multiple imaging exams when purchased together.
Your health spending account or group medical insurance plan may cover the cost of a private CT that is prescribed by a qualified health care practitioner. You will need to check with your plan administrator for coverage details.
Whether public or private, medical imaging must be requested by a health care practitioner who will provide a requisition. Your medical and family history, risk factors, and type and duration of symptoms, all affect a referring physician’s decision on which type of imaging is appropriate.
When we receive your requisition Mayfair Diagnostics will schedule your exam and provide you with detailed information to prepare for it. Once your exam is completed, your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor.
For more information about CCTA, visit the exam page for preparation and procedure information.
Knaapen, P. (2019) “Computed Tomography to Replace Invasive Coronary Angiography?” www.ahajournals.org. Accessed August 15, 2022.
Mayo Clinic Staff (2021) “Coronary angiogram.” www.mayoclinic.org. Accessed August 15, 2022.
Parikh, R., et al. (2020) “Cardiac Computed Tomography for Comprehensive Coronary Assessment: Beyond Diagnosis of Anatomic Stenosis.” Methodist Debakey Cardiovasc Journal. Apr-Jun; 16(2): 77–85.
Healthwise Staff (2021) “Computed Tomography Angiogram (CT Angiogram).” www.myhealth.alberta.ca. Accessed August 15, 2022.
Radiological Society of North America (2022) “Coronary CTA.” www.radiologyinfo.org. Accessed August 15, 2022.
Stefanini, G. G. and Windecker, S. (2015) “Can Coronary Computed Tomography Angiography Replace Invasive Angiography?” American Heart Association Journals. January 26, 131: 418-426
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Computed tomography (CT) is an advanced imaging system that uses a combination of X-rays and computer technology to produce comprehensive images of your abdomen. CT scans give a much more detailed picture than regular X-rays and can identify many conditions that may escape detection on other imaging tests.
Your health care practitioners may order an abdomen CT scan to examine one of the following (or, for a more comprehensive exam, a combined abdomen/pelvis CT):
A cause of pain or swelling.
Lymph nodes or blood vessels.
The kidney or bladder.
The liver, pancreas, or spleen.
The small or large bowel.
HOW DO I PREPARE FOR MY EXAM?
WITHOUT CONTRAST: If contrast is not used, you will need to fast for two hours prior to your appointment.
ORAL CONTRAST: If oral contrast is prescribed, you will need to fast for four hours prior to your appointment and arrive two hours prior to your exam, unless otherwise specified at the time of booking.
IV CONTRAST: If oral contrast and/or IV contrast is prescribed, please arrive 15 minutes before your appointment to allow enough time to check-in with reception.
Bring photo identification and your provincial health card.
Please do not drink coffee, tea, or juice six hours prior to your exam.