Pulse: Health: A Coronary Close-Up
Perry Weinstock wasn’t sure why his patient, a 55-year-old Cherry Hill resident, was suffering chest pains severe enough to send her to the ER. She’d breezed through her stress tests, yet she did have a troubling family history of heart disease.
Five years ago, the Cooper Hospital cardiologist would have scheduled his patient for a cardiac catheterization, an invasive, somewhat risky test in which a catheter is threaded from the groin to the heart to look for blockages. An outpatient procedure, it costs about $5,000. Now, Weinstock recommends a simple, noninvasive alternative called CTA (coronary CT angiography), done by a three-dimensional, 360-degree high-tech machine that images coronary circulation in a 15-second procedure. So a week later, his patient hopped on the Atlantic City Expressway and drove to Atlantic Medical Imaging, a radiology center a few miles from casino land. After she lay down on a table that rested in the hole of a large electronic doughnut, a technician injected a contrast dye into her arm and adjusted the radiation dose to her size and weight. While she briefly held her breath, the scanner took computerized pictures of her heart. By the time she’d gotten dressed, she had the results: Blood was flowing through her coronary arteries as smoothly as oil through a pipeline. Her pain wasn’t heart-related.
The test wasn’t covered by insurance — it cost her $1,200 out of pocket — but the peace of mind was well worth it, she says. “Why would I put myself through the risk and inconvenience of a catheterization when I could have this easy, noninvasive test instead?”
For years, cardiac catheterization has been the gold standard for checking out chest pains when a patient flunks a stress test. It identifies when arteries are narrowed and gives doctors an opportunity to open them with a stent or a balloon angioplasty. But catheterization, besides being invasive and costly, can’t show the early formation of vulnerable soft plaque, which, if it ruptures, is a primary cause
of heart attacks. One great advantage of a CTA is its ability to reveal soft plaque forming when there are no symptoms and when a stress test may be negative. This early warning is especially useful for prevention.
The cardiac community has mixed feelings about CTA. Proponents like David Dowe, a partner at Atlantic Medical Imaging, believe the test will alter the practice of cardiology. “If Bill Clinton had had a coronary CT scan after he passed his stress test, they’d have picked up his disease early and treated it,” Dowe asserts (presumably sparing the former president bypass surgery). “Eventually this will become as common a screening device as a colonoscopy.” Thomas Jefferson radiologist Vijay Rao, who was instrumental in bringing the technology to her hospital, predicts, “CT angiography will revolutionize the diagnosis of coronary artery disease.”
But others are concerned about unnecessary usage of the procedure and profit-driven abuse. “It’s loaded with a high potential for overuse when not properly indicated,” says Sheldon Goldberg, of Hahnemann University Hospital. “Doctors will set up centers, start marketing the scans and doing them willy-nilly. We need to establish very careful guidelines for when, where and how to use this.” Jefferson radiologist David Levin agrees. “We shouldn’t do this test on patients with no symptoms or risk factors. I worry that anybody who can afford it will want it. Often the scan will find something harmless that requires more investigating or shouldn’t really be treated, and this will overburden the health system.”