Advocates say it is possible to see plaque on the arteries with CT angiography.
However, coronary angiography is often used to diagnose exactly what's the cause of the chest pain.
While traditional angiography is invasive, he adds, the risks are exceedingly low when performed by an experienced clinician.
The gold standard is X-ray angiography, in which a reflective dye is injected into the patient via catheter.
Poon, by many accounts a very bright doctor, is a big proponent of a new technology called CT angiography.
However, the followup to COURAGE, the ISCHEMIA trial, will randomize ischemic patients to PCI or OMT without prior angiography.
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Critics of cardiac CT angiography question whether its benefits warrant its current widespread use and the amount of radiation exposure.
The researchers reported that the pictures they saw of the heart's arteries compared well with those obtained by angiography and X-ray.
The trial was designed to address the limitations of COURAGE, in which CAD patients as documented by angiography were randomized to PCI or OMT.
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The good news is that there is also a CT scan available to detect fatty deposits that constitute soft plaque, called a Coronary CT Angiography (CTA).
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Patients who undergo cardiac CT angiography are within their rights to ask about what strategies, if any, are being used to reduce radiation dosage, he said.
Dr Gregory Lip, a consultant cardiologist and reader in medicine at the Birmingham City Hospital, said that anything that reduced the small risks of angiography was to be welcomed.
In the new study, Hausleiter and his colleagues looked at patients who underwent cardiac CT angiography at 21 university hospitals and 29 community hospitals between February and December 2007.
"Probably the group of centers which were studied in this paper are more sophisticated and more aware of radiation-reduction methods than your typical center that is performing cardiac CT angiography, " he says.
When cardiac CT angiography is being used appropriately -- meaning, for example, in people with chest pain suggesting blocked heart arteries, rather than as a screening test for people with no symptoms of heart disease -- the benefits far outweigh the risk of the radiation, according to Einstein and Hausleiter.
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