THE BEST CARDIOLOGISTS IN YELAHANKA
Indications for coronary angiography
1 Angina not responding to medical treatment in a patient without contraindications
(e.g. extreme old age—usually older than about 85 these days—or severe co-morbidities)
to cardiac surgery or angioplasty.
2 Continuing chest pain whose cause is not clear despite non-invasive investigations. The
procedure may well be worthwhile if it reveals normal coronary arteries and prevents a
patient being treated unnecessarily with more and more anti-anginal drugs. Non-invasive
investigations are more often equivocal in women, and more women than men are found
to have normal coronaries at angiography.
3 Preparation of a patient older than 35 or so for some other cardiac surgery (e.g. valve replacement).
The surgeon needs to know whether significant coronary disease is present so that
coronary grafting can be performed at the time of valve surgery. Otherwise, patients are at
risk of ischaemic problems in the post-operative period.
4 Diagnosis of cardiomyopathy (p. 267) by excluding coronary artery disease and infarction
as the cause of angina or cardiac failure. These patients may benefit from revascularisation
if significant coronary disease is also present (‘ischaemic cardiomyopathy’).
5 Investigation of patients following myocardial infarction. Routine transfer to a centre with
angiographic facilities after successful thrombolytic treatment is a grade D recommendation.
There is no proof that a patient without continuing ischaemia has an improved prognosis
when angiography and revascularisation are carried out routinely after infarction. The Open
Artery Trial results suggest there is no benefit compared with optimal medical treatment
for patients without ischaemic symptoms in having an occluded vessel opened five days or
more after an infarction.
However, spontaneous or induced ischaemia (by modified stress testing or perfusion
imaging) leads to a grade B recommendation for angiography and intervention.
The management of post-infarct patients is definitely easier if the coronary anatomy is
known, and many units adopt the policy of early (within a week) angiography of infarct
patients without contraindications to revascularisation.
6 Non-ST elevation acute coronary syndromes (p. 156).
7 Acute myocardial infarction in a unit where primary angioplasty can be performed