Which test is better, a nuclear stress test or CCTV?

My nuclear stress test says low risk. My CCTV said extensively calcified LAD with suspicion of > 70% obstruction. This seems contradictory. Which is the better test?

Submitted by Kathy from Long Island, NY on 02/11/2017

by Patrick J. Cook, MD

They’re looking at two different things. The “CCTV” counts total coronary calcium. The amount of calcium correlates with the total amount of plaque in the coronary circulation. It does not speak to the presence or absence of any tight lesions in that circulation. The nuclear study looks to see if there are any areas of the heart that are not being well perfused (i.e., not getting enough blood), which would in turn suggest that there is a significant narrowing as its cause. In fact, if one has a high calcium score and no symptoms, the recommendation is for a nuclear stress test. Aggressive risk factor management is obligatory in light of a high calcium score.