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            Case presentation #1


Clinical information

This 60 year old man was referred for CT coronary angiography by his primary care physician because of possible statin intolerance. The patient had both diabetes (II) and hyperlipidemia but was experiencing vague muscle discomfort which he attributed to statin therapy. The referring physician wanted to assess the need for continued statin therapy.


CT angiography results 


Despite a low calcium score of only 16, the patient had a moderately stenotic non-calcific plaque of the proximal LAD artery. Clearly continued aggresive statin therapy is warranted.



If the referring physician had chosen instead to perform either a nuclear perfusion stress test or a stress echocardiogram, the results likely would have been "normal" since this is not a hemodynamically significant lesion. That course of action would have been falsely reassuring and might well have led to the wrong therapeutic decision. Physicians need to remember that normal functional stress tests do not necessarily mean normal coronary arteries. CT angiography is the only noninvasive test which can detect coronary artery disease in its earliest phases when plaque is not causing significant stenosis.   


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