Coronary Angiography for Diagnosing Coronary Artery Disease

Indications for Coronary Angiography

• The American College of Cardiology recommends coronary angiography for patients with presumed stable ischemic heart disease who have persistent, unacceptable ischemic symptoms despite optimal medical therapy and who are amenable to coronary revascularization 1, 2, 3, 4
• The European Society of Cardiology suggests proceeding directly to invasive coronary angiography in patients with very high (>85%) clinical likelihood of obstructive CAD, severe symptoms refractory to medical therapy, angina at low exercise levels, and/or high event risk 5, 6
• The American Heart Association recommends coronary angiography for patients who have survived sudden cardiac death or life-threatening ventricular arrhythmia 7, 8
• The American College of Cardiology recommends coronary angiography for patients with heart failure and angina or significant ischemia (unless not eligible for revascularization) 9

Technical Considerations for Coronary Angiography

• The European Heart Journal recommends using radial artery access as the preferred approach for invasive coronary angiography, as it reduces mortality and major bleeding compared to femoral access 5, 6
• The European Society of Cardiology suggests having coronary pressure assessment (FFR/iFR) readily available to evaluate functional severity of intermediate stenoses (40-90% for non-left main, 40-70% for left main) 5, 6

Non-Invasive Testing for Coronary Artery Disease

• The European Society of Cardiology recommends a structured approach, using either coronary CT angiography (CCTA) or functional imaging as initial testing in patients with >5% pretest probability 5
• The European Heart Journal prefers CCTA for ruling out obstructive CAD in patients with low-to-moderate (>5%-50%) pretest probability 5
• The European Society of Cardiology recommends functional imaging if CCTA shows CAD of uncertain functional significance 5