What are the indications for coronary angiography?

Coronary angiography is a commonly used and effective method for diagnosing coronary atherosclerotic heart disease (CHD). It is a relatively safe and reliable invasive diagnostic technology. It is now widely used in clinical practice and is considered to be the "gold standard" for diagnosing CHD. Let us now understand the indications for coronary angiography.

Indications for coronary angiography

Coronary angiography may be considered in the following clinical situations:

1. Unexplained chest pain, clinical suspicion of coronary heart disease, and non-invasive examinations cannot confirm the diagnosis;

2. Unexplained arrhythmia, sometimes requiring coronary angiography to exclude coronary heart disease;

3. Unexplained left ventricular dysfunction;

4. Asymptomatic but suspected of coronary heart disease;

5. For patients with stable angina or old myocardial infarction, the improvement of lifestyle and the best drug treatment are ineffective, affecting the quality of life; 6. For patients with unstable angina, especially those clinically judged to be at high risk, coronary angiography can be performed directly;

7. Patients with asymptomatic coronary heart disease, especially those with positive exercise test and obvious risk factors;

8. Patients with acute myocardial infarction within 6 hours of onset or persistent chest pain for more than 6 hours after onset, who are planning to undergo emergency coronary artery recanalization;

9. Patients with moderate or above coronary artery stenosis or unstable plaques found or highly suspected by coronary artery CT angiography or other imaging examinations;

10. Before major surgeries for congenital heart disease, valvular disease, etc.;

11. Successful resuscitation of primary cardiac arrest requires evaluation of the coronary arteries and early intervention of vascular lesions if necessary;

12. Recurrent angina pectoris after percutaneous coronary intervention or coronary artery bypass grafting.

Advantages and disadvantages of coronary angiography

Advantages: a. It has good imaging effect and is currently the gold standard for diagnosing coronary heart disease, with very low false positive and false negative rates; b. Once a problem is found, stent implantation can be carried out immediately after angiography, which means that the problem can be discovered and solved quickly.

Disadvantages: a. Although it is minimally invasive, it is still traumatic; b. Although it is low-risk, a preoperative signature interview is still required; c. The cost is relatively high.

Indications for coronary angiography

1. Patients with a history of chest pain but atypical symptoms and need a clear diagnosis;

2. Patients who have been diagnosed with coronary heart disease but have poor medical treatment results and are planning to undergo coronary artery bypass grafting or PTCA (percutaneous transcoronary angioplasty);

3. Emergency PTCA can be performed in the early stage of acute myocardial infarction (within 6 hours of onset). Emergency coronary angiography is required when acute myocardial infarction is combined with refractory shock or ventricular septal perforation requires emergency heart surgery.

4. Patients with recurrent angina pectoris or positive exercise test after myocardial infarction;

5. Although there is no history of angina pectoris or myocardial infarction in the past, the electrocardiogram (including dynamic electrocardiogram, exercise test) shows ischemic ST-T changes or pathological Q waves that cannot be explained by other reasons;

6. Follow-up observation of patients diagnosed with coronary heart disease. If the condition worsens after the first angiography, coronary angiography can be performed again to understand the progression of the disease and explore whether medical treatment is appropriate;

7. If angina pectoris recurs after coronary artery bypass grafting, selective coronary angiography, including angiography of the graft vessels, is required to understand whether the graft vessels are unobstructed and whether new lesions have appeared;

8. Patients with valvular heart disease who have dynamic ST-T changes may have concurrent coronary heart disease and should undergo selective coronary angiography. Before surgical treatment of valvular heart disease, angiography should be performed even if there are no ST-T changes. The purpose is to better understand coronary perfusion during surgery.

9. Congenital heart disease is prone to be combined with congenital coronary artery malformation. The coronary artery should not be damaged during surgery and large coronary artery malformations that can be corrected should be corrected during surgery. Selective coronary angiography is required before surgery.

10. Patients with unexplained heart failure, cardiac enlargement, and arrhythmia often need coronary angiography to confirm the diagnosis when it is difficult to make a clinical diagnosis.

11. Health examination for people engaged in special occupations (such as pilots, etc.).