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Invasive Coronary Angiography

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Atherosclerosis: Clinical Perspectives Through Imaging

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Abstract

For several decades invasive coronary angiography has been the reference standard test for the assessment of coronary artery disease. The proper delineation of coronary artery disease extent and lesion quantification on invasive coronary angiography requires attention on the part of the operator to clearly display the entire coronary arterial tree and coronary artery disease lesions, while avoiding artifact, vessel overlap and/or foreshortening using this 2-dimensional imaging technique. The majority of coronary artery lesions visualized is assessed by visual estimation of lumen diameter stenosis. However, while visual estimation of diameter stenosis is practical and generally accurate, coronary artery disease lesion severity may be improved with use of quantitative coronary angiography (QCA), intravascular ultrasound or with the use of fractional flow reserve to assess hemodynamic effects related to the stenosis in question. Although not a high risk procedure on a per-patient basis with a risk of major complications below 1 %, serious complications from invasive coronary angiography do occur, including arterial injury, arrhythmia, myocardial infarction, stroke and death. More common but less morbid risks include renal dysfunction, allergy to contrast media, bleeding, hematoma, arteriovenous fistula, peripheral nerve injury, or risks of conscious sedation such as aspiration. Because of these risks noninvasive approaches to diagnostic coronary angiography have evolved, but do not allow for additional diagnostic or therapeutic maneuvers such as intravascular ultrasound, fractional flow reserve, or percutaneous coronary intervention (Table 6.1). Angiographic data including lesion location, severity, and anatomy correlate with prognosis for future events both with and without coronary intervention using scales such as the Duke Prognostic Score and Syntax scale. For all these reasons, invasive coronary angiography remains vitally important for visualization of coronary artery disease.

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References

  1. Fraker Jr TD, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 2007;50(23):2264–74.

    Article  PubMed  Google Scholar 

  2. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41(1):159–68.

    Article  PubMed  Google Scholar 

  3. Anderson JL, Adams CD, Antman EM. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50(7):e1–157.

    Article  PubMed  Google Scholar 

  4. Krumholz HM, Anderson JL, Brooks NH, et al. ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures on ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2006;47(1):236–65.

    Article  PubMed  Google Scholar 

  5. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008;51(2):210–47.

    Article  PubMed  Google Scholar 

  6. Zanzonico P, Rothenberg LN, Strauss HW. Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward. J Am Coll Cardiol. 2006;47(9):1846–9.

    Article  PubMed  Google Scholar 

  7. McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103(5):368–75.

    Article  PubMed  CAS  Google Scholar 

  8. Baim DS. Grossman’s cardiac catheterization, ­angiography, and intervention. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.

    Google Scholar 

  9. Hutchins GM, Bulkley BH, Ridolfi RL, Griffith LS, Lohr FT, Piasio MA. Correlation of coronary arteriograms and left ventriculograms with postmortem studies. Circulation. 1977;56(1):32–7.

    Article  PubMed  CAS  Google Scholar 

  10. Schwartz JN, Kong Y, Hackel DB, Bartel AG. Comparison of angiographic and postmortem findings in patients with coronary artery disease. Am J Cardiol. 1975;36(2):174–8.

    Article  PubMed  CAS  Google Scholar 

  11. DeRouen TA, Murray JA, Owen W. Variability in the analysis of coronary arteriograms. Circulation. 1977;55(2):324–8.

    Article  PubMed  CAS  Google Scholar 

  12. Bjork L, Spindola-Franco H, Van Houten FX, Cohn PF, Adams DF. Comparison of observer performance with 16 mm cinefluorography and 70 mm camera fluorography in coronary arteriography. Am J Cardiol. 1975;36(4):474–8.

    Article  PubMed  CAS  Google Scholar 

  13. Brown BG, Bolson E, Frimer M, Dodge HT. Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation. 1977;55(2):329–37.

    Article  PubMed  CAS  Google Scholar 

  14. Raichlen JS, Healy B, Achuff SC, Pearson TA. Importance of risk factors in the angiographic progression of coronary artery disease. Am J Cardiol. 1986;57(1):66–70.

    Article  PubMed  CAS  Google Scholar 

  15. Holmes Jr DR, Elveback LR, Frye RL, Kottke BA, Ellefson RD. Association of risk factor variables and coronary artery disease documented with angiography. Circulation. 1981;63(2):293–9.

    Article  PubMed  Google Scholar 

  16. Betriu A, Pare JC, Sanz GA, et al. Myocardial infarction with normal coronary arteries: a prospective clinical-angiographic study. Am J Cardiol. 1981;48(1):28–32.

    Article  PubMed  CAS  Google Scholar 

  17. Fournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA, Gonzalez-Barrero A. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol. 1996;19(8):631–6.

    Article  PubMed  CAS  Google Scholar 

  18. Fournier JA, Sanchez-Gonzalez A, Quero J, et al. Normal angiogram after myocardial infarction in young patients: a prospective clinical-angiographic and long-term follow-up study. Int J Cardiol. 1997;60(3):281–7.

    Article  PubMed  CAS  Google Scholar 

  19. Chaitman BR, Bourassa MG, Davis K, et al. Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation. 1981;64(2):360–7.

    Article  PubMed  CAS  Google Scholar 

  20. Mark DB, Nelson CL, Califf RM, et al. Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. Circulation. 1994;89(5):2015–25.

    Article  PubMed  CAS  Google Scholar 

  21. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus ­coronary artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    Article  PubMed  CAS  Google Scholar 

  22. Patel MR, Peterson ED, Dai D. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362(10):886–95.

    Article  PubMed  CAS  Google Scholar 

  23. Libby P, Bonow RO, Mann DL, Zipes DP, Braunwald E. Braunwald’s heart disease. 8th ed. Philadelphia: Saunders Elsevier; 2007.

    Google Scholar 

  24. Kern MJ. The cardiac catheterization handbook. Philadelphia: Elsevier; 2003.

    Google Scholar 

  25. Yusuf S, Zucker D, Passamani E. Effect of coronary artery bypass graft surgery on survival: overview of 10 year results from randomized trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344(8922):563–70.

    Article  PubMed  CAS  Google Scholar 

  26. Smith SC, et al. ACC/AHA Guidelines for percuta­neous coronary intervention (Revision of the 1993 PTCA Guidelines)—Executive Summary : a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty) Endorsed by the Society for Cardiac Angiography and Interventions. Circulation. 2001;103(24):3019–41.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Non-Invasive Cardiovascular Imaging, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Eddie Hulten M.D., MPH

  2. Department of Radiology, Fort Belvoir Community Hospital, Fort Belvoir, VA, 22060, USA

    Daniel William Carlson Jr M.D.

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  1. Eddie Hulten M.D., MPH
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  2. Daniel William Carlson Jr M.D.
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Correspondence to Eddie Hulten M.D., MPH .

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Editors and Affiliations

  1. MedStar Washington Hospital Center, Irving Street 110, Washington, 20010, District of Columbia, USA

    Allen J. Taylor

  2. Walter Reed Army Medical Center, Georgia Avenue, Washington, 20307, Washington, USA

    Todd C. Villines

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Hulten, E., Carlson, D.W. (2013). Invasive Coronary Angiography. In: Taylor, A., Villines, T. (eds) Atherosclerosis: Clinical Perspectives Through Imaging. Springer, London. https://doi.org/10.1007/978-1-4471-4288-1_6

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  • DOI: https://doi.org/10.1007/978-1-4471-4288-1_6

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4287-4

  • Online ISBN: 978-1-4471-4288-1

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