CT coronary angiography (CTCA) can either boost or reduce chest pain symptoms depending on what the scan uncovers.

If the scan shows no coronary disease or partial blockage, patients tend to feel better. When little or no blockage is found, however, patients with chest pain may feel worse.

“Patients with normal coronary arteries or those with severe coronary artery disease seemed to get the most benefit in quality of life and did best,” senior study author Dr. David E. Newby from University/BHF Center for Cardiovascular Science in Edinburgh, told Reuters Health.
“This suggests that being reassured that all is normal is highly valued by patients, and CTCA really helps provide this reassurance. Conversely, knowing the cause of your symptoms is due to coronary heart disease and patients undergoing treatment for it, is also very helpful,” he told the news service.

Researchers in the Scottish Computed Tomography of the Heart (SCOT-HEART) trial found that CTCA in addition to standard care, “clarified the diagnosis of angina pectoris due to coronary heart disease.”

They also found this led to a better selection of patients for “invasive coronary angiography, more appropriate changes in therapy and a halving of the rates of fatal and non-fatal myocardial infarction.”

A total of 4,146 patients with possible angina from coronary heart disease took part in the trial.

CTCA's impact on symptoms and quality of life was looked at six weeks and six months after the scanning.

Better symptomatic outcomes were associated with scans in patients with a clinical diagnosis of angina pectoris that showed that there was no coronary heart disease. “This led to the cancellation of unnecessary anti-anginal and preventative therapies, and was associated with the better improvements in symptoms and quality of life,” the researchers reported in the British Medical Journal.

The scans are a bit of a two-edged sword. “Although CTCA removes diagnostic uncertainty and halves the rate of subsequent heart attacks, quality of life can be negatively impacted in those who are worried about their health and are found to have nonobstructive coronary artery disease,” Newby told Reuters, adding that, “much like screening tests for cancer, being told you have heart disease does not make the patient feel better.”

A researcher who has studied the links between personality and coronary artery symptoms discussed the implications of the study with the wire service. “It was striking for me that health status was very much related to receiving a [treatable] diagnosis or excluding such a diagnosis, rather than experiencing angina symptoms per se,” said Dr. Paula M. C. Mommersteeg from the Center of Research on Psychology in Somatic Diseases, Tilburg University.

Cardiology Homepage