Indications for Coronary Angiography

HealthCare

[To be completed]

Read this article: Am Fam Physician. 2017 Feb 15;95(4):232-240.

Strong recommendations to perform coronary angiography made by AHA (etc) in 2012

  • As an initial test in patients who have survived sudden cardiac arrest or potentially life-threatening ventricular arrhythmia or in those who develop symptoms and signs of heart failure.
  • When a patient’s clinical characteristics and the results of noninvasive testing indicate a high likelihood of severe ischemic heart disease.

Weaker recommendations for coronary angiography in patients with SIHD

  • Depressed left ventricular systolic function (ejection fraction <50 percent) and moderate risk criteria on noninvasive testing with demonstrable ischemia.
  • Inconclusive prognostic information after noninvasive testing or in patients for whom noninvasive testing is contraindicated or inadequate.
  • An unsatisfactory quality of life due to angina, a left ventricular ejection fraction >50 percent, and intermediate risk criteria on noninvasive testing.

Indications for patients with stable ischemic heart disease (SIHD)

“There are two primary indications for coronary angiography followed by revascularization of appropriate lesions
-Angina that significantly interferes with a patient’s lifestyle despite maximal tolerable medical therapy.
-Patients with high-risk criteria and selected patients with intermediate-risk criteria on noninvasive testing, regardless of anginal severity.

We also believe coronary angiography is reasonable in patients with atypical symptoms and equivocal findings on stress testing in whom a diagnosis needs to be established” Uptodate.com

PCI Versus Medical Therapy

“No study to date has demonstrated that PCI in patients with SIHD improves survival rates… Evaluation of 61 trials of PCI conducted over several decades shows that despite improvements in PCI technology and pharmacotherapy, PCI has not been demonstrated to reduce the risk of death or MI in patients without recent ACS” Circulation 2012.

PCI Versus Medical Therapy (see section 5.5 in circulation 2012, below)

References

Am Fam Physician. 2017 Feb 15;95(4):232-240. https://www.aafp.org/afp/2017/0215/p232.html

Circulation. 2012 Dec 18;126(25):e354-471. https://www.ncbi.nlm.nih.gov/pubmed?term=23166211

http://circ.ahajournals.org/content/99/17/2345.full

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