False positives and false negatives are taken into account as “side effects” or adverse outcomes for imaging studies. Although a cardiac CT does not use contrast, other imaging studies do and can cause allergic reaction and or kidney problems.
The Cardiac CT is a nice study to have, but doesn’t really take the place of any existing studies. It is a static test (image) so does not give dynamic feedback such as a stress test, and of course, a heart catheter can treat CAD via angioplasty and stent placement. Cardiac CTs are nice when patients do not want to treat their blood pressure or take statins etc, and then can be shown what sort of disease burden their coronary arteries are actually carrying to add information to the discussion.
“The Cardiac CT is a nice study to have, but doesn’t really take the place of any existing studies. It is a static test (image) so does not give dynamic feedback such as a stress test, and of course, a heart catheter can treat CAD via angioplasty and stent placement. Cardiac CTs are nice when patients do not want to treat their blood pressure or take statins etc, and then can be shown what sort of disease burden their coronary arteries are actually carrying to add information to the discussion.”
My reluctance to take statins - after they immediately started causing severe muscle cramps - was exactly why my PCP suggested a cardiac CT. The result was an almost off-the-charts high score, so he ordered a stress test.
I had it done at a large heart-health hospital and it was interpreted by the chief cardiologist. My time-to-exhaustion was 50% greater than the norm for my age/sex, and the color Doppler echocardiogram showed no anomalies. He said that the cardiac CT was a useful guideline but that it was by no means absolute. He said he had patients with a score of 5000 (mine was 1250) with no issues, and some with a score of zero who had arterial blockage.
Prior to getting called away for an emergency, he mentioned something about my score being possibly related to a “genetic polymorphism” but he wasn’t able to elaborate. He said that if I managed the obvious risk factors (weight, BP, etc), my risk for a cardiac event should be no higher than average for man my age.