Indications for Coronary Angiography

Since the first serendipitous selective coronary angiography was performed by pediatric cardiologist Dr. Mason Sones in 1958 during ventriculography and aortography (Sones et al., 1959), invasive coronary angiography has become well established as the diagnostic gold standard for coronary artery disease. Coronary angiography provides definitive information of “luminology” (radiographic outline using a contrast agent) of the coronary arteries. It is the standard with which other diagnostic modalities are compared. Millions are performed annually worldwide. Whilst the risk of coronary angiography of complications is very low in experienced hands the procedure is invasive and, requires dedicated infrastructure and expense. There are certain specific indications for coronary angiography. The general indication for a coronary angiography is to define the coronary artery anatomy. More detailed guidelines for coronary angiography date back to 1999 from the American College of Cardiology (Scanlon et al., 1999). This of course predated the enormous technological advancement over the past decade, the development in computed tomography coronary angiography, the widespread adoption of coronary stenting, the improvement afforded by drug eluting stents, and the availability of new antiplatelet therapy that enhanced the safety of all coronary interventions. This chapter examines the appropriate indications for invasive coronary angiography in the current era, assesses the role of non invasive CT coronary angiography, and incorporates the emerging adjunctive role in the management of patients undergoing percutaneous cardiac structural interventions. Case vignettes are included in this chapter to illustrate the indications and use of coronary angiography in the current era. It must be stressed whilst guidelines do provide recommendations regarding the indications for invasive coronary angiography, many more complex clinical and non clinical factors exist for each individual patient and the clinician must exercise clinical acumen to proceed to perform an invasive diagnostic and/or therapeutic procedure.