CTA with unexpected finding

[dwk]

I'm a 52 year old, white male with a strong family history of CAD, bad genes and life style -- overweight -- not obese, hypertension, elevated lipids (could be the poster boy for metabolic X) -- fairly active, but no exercise routine.

About five years ago, after an stressful incident with my son, I developed some non-specific angina. Had a stress test with perfusion imaging -- during exercise, drop st segments in chest leads 2-3mm. Reach stage 4 with no chest pain and perfusion images stone cold normal.

Due to family history, I get a stress/perfusion study every 2-3 years. Results have been the same as the initial study.

Cardiology group is doing a CTA research study and I was offered the chance to partcipate. Had the CTA scan last week and these were the findings.

Calcium score - 0
60% stenosis in proximal LAD

So I'm trying to decide the best why to manage this.

The one option is to get very aggressive with my meds (currently taking asprin, pravachol -80mg, tricor -145mg and benicar -40; blood pressure and lipids are controlled). Maybe target ldl to 75, and get my fat a$$ out of the chair and away from the computer.

The other option is to have a cath and angioplasty/stent . But don't like the idea of taking Plavix the rest of my life.

If this stenosis was in my RCA or even distal LAD, I wouldn't be as concerned. My greatest fear is 50% of MI victims don't survive. Given the strong family history, ECG changes during exercise and now the finding on the CTA scan, I'm trying to decide the proper course of action.

It's my understanding that since my calcium score is 0, that the stenosis is a soft plaque which is of greater risk compared to a stable plaque.

Given my fairly decent level of exercise on the stress test, the lack of chest pain and the normal perfusion scan -- I'd prefer to go the aggressive meds and life style changes -- I just wished the stenosis was somewhere else.

Any thoughts, experiences? See the Cardiologist next week to go over my options.

Thanks!!!
dwk

[Buckeye]

What does CTA stand for?

[Rich_by_the_Bay]

Quote:

Originally Posted by dwk Given my fairly decent level of exercise on the stress test, the lack of chest pain and the normal perfusion scan -- I'd prefer to go the aggressive meds and life style changes -- I just wished the stenosis was somewhere else. Any thoughts, experiences? See the Cardiologist next week to go over my options.

DWK, the information you provide is excellent but not complete technically. Check with your cardiologist to be sure. CTA = computerized tomographic angiogram, a noninvasive way of assessing blood flow in the arteries.

The normal exercise imaging despite ST segment depression on EKG is reassuring. CTA remains an unproven and iffy modality for coronary disease prognosis, and I personally find the nuclear study to be more consistently reliable, at least prognostically. I have seen discrepancies between CTAs or EB-CTs and cath results.

Whatever your cardiologist recommends, sounds like a good time to get your risk factors under serious control. Maybe he or she will advise repeating the nuclear stress after some serious lifestyle modification and statins for about 6 months or a year.

Blessing in disguise, if you get your risk factor act together. Do whatever your cardiologist advises, after reviewing all the options.

P.S. Now that I have confused everyone but you, the bottom line is that an experimental test showed the possibility of important coronary disease, while conventional studies were ambiguous at best. I am guessing that 6-12 months of major lifestyle modification and statins followed by a repeat nuclear stress test will be among the options discussed. Good luck.