Coronary angiography is used to investigate the anatomy of the coronary arteries and to assess the number, location and severity of possible coronary stenoses.
In the case that a significant stenosis is found it is possible at the same time to perform a therapeutic intervention, i.e. balloon angioplasty (also using a drug-eluting balloon) and, if needed, insertion of a metal mesh (bare-metal or drug-eluting stent) to secure the patency of the vessel.
Indications
Angina pectoris or other symptom triggered by exertion
Exercise-related angina pectoris symptoms (chest pain, dyspnoea, fatigue) during medication and a very high pretest probability of CHD (> 85%): consider either coronary angiography or other type of diagnostic imaging.
Exercise-related symptoms that repeatedly disturb the life of the patient despite optimal medication, when the pretest probability of CHD is 15-85% and the patient has findings suggestive of ischaemia either in an exercise stress test or in another diagnostic imaging study.
Exercise-related angina pectoris symptoms (chest pain, dyspnoea, fatigue) during medication, when the pretest probability of CHD is ≥ 15% and the patient has some other finding suggestive of ischaemia (reduced left ventricular function or a local wall motion disturbance, arrhythmias).
Acute chest pain
ST elevation myocardial infarction (STEMI): coronary angiography should be performed as soon as possible; see Acute coronary syndrome and myocardial infarction Acute Coronary Syndrome and Myocardial Infarction.
Non-ST segment elevation myocardial infarction (NSTEMI): coronary angiography is performed according to the clinical situation, nonetheless within 2-72 hours; see Acute coronary syndrome and myocardial infarction Acute Coronary Syndrome and Myocardial Infarction.
Other indications
Heart failure of unknown aetiology or wall motion disturbance: search for the cause
As further investigation in a patient surviving resuscitation after ventricular fibrillation
Assessment of invasive management of a valvular heart disease