Chronic stable angina coronary angiography
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina coronary angiography On the Web | ||
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to Hospitals Treating Chronic stable angina coronary angiography | ||
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Risk calculators and risk factors for Chronic stable angina coronary angiography | ||
Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editor-in-Chief: Smita Kohli, M.D.
Coronary Angiography
Indications:
- The principal indication for coronary angiography in patients with stable angina pectoris with or without previous myocardial infarction is the consideration of coronary revascularization.
- Occasionally, coronary angiography is recommended for diagnostic purposes because the patient’s clinical presentation and noninvasive test results are inconclusive. Even, if a vasospastic angina diagnosed by noninvasive studies, coronary angiography is indicated to determine whether a fixed coronary artery stenosis is present in addition to the spasm.
- The indications for coronary angiography in patients with walk through angina,mixed angina, and postprandial angina are similar to those in patients with stable exertional angina.
- Coronary angiography is the most useful in the following situations:
- Exclude anatomical abnormalities in young patients as the cause of angina.
- Failure to make a definitive diagnosis after noninvasive tests
- Patients with suspected coronary artery spasm who require provocative tests
- Sudden cardiac death survivors
- Conditions causing inability to perform noninvasive tests.
- Probability of left main coronary artery stenosis or multi vessel disease.
- Occupational requirement for a firm diagnosis.
- It should be appreciated, however, that the demonstration of the presence of one or more critical coronary artery stenosis does not necessarily indicate that they are the cause of a chest pain syndrome. Furthermore, typical angina pectoris can occur in the absence of obstructive atherosclerotic CAD, thus raising the question of the presence of vasospastic angina, the metabolic syndrome X, or non ischemic causes of chest pain.
Diagnostic:
- In general, a stenosis of 50% or more of the luminal diameter, which corresponds to a reduction of 70% or more of the cross sectional area, is considered significant coronary artery disease (CAD), since stenosis of this severity reduces coronary blood flow with exercise even though more severe stenosis are required to reduce flow at rest.
- A 70% stenosis of luminal diameter corresponds to a 90% cross-sectional area stenosis, and may result in angina at rest.
- The extent of coronary artery disease (CAD) is often expressed in terms of the number of major epicardial coronary arteries with ≥50% diameter stenosis.
Pretest probability:
- When the probability of severe angina is low, noninvasive tests are more appropriate.
- When the pretest probability is high, direct referral for coronary angiography is a suitable choice.
ACC / AHA Guidelines- Coronary Angiography (DO NOT EDIT)[1]
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Class I1. Patients with known or possible angina pectoris who have survived sudden cardiac death. (Level of Evidence: B) Class IIa1. Patients with an uncertain diagnosis after noninvasive testing in whom the benefit of a more certain diagnosis outweighs the risk and cost of coronary angiography. (Level of Evidence: C) 2. Patients who cannot undergo noninvasive testing due to disability, illness, or morbid obesity. (Level of Evidence: C) 3. Patients with an occupational requirement for a definitive diagnosis. (Level of Evidence: C) 4. Patients who by virtue of young age at onset of symptoms, noninvasive imaging, or other clinical parameters are suspected of having a nonatherosclerotic cause of myocardial ischemia (coronary artery anomaly, Kawasaki disease, primary coronary artery dissection, radiation-induced vasculoplasty). (Level of Evidence: C) 5. Patients in whom coronary artery spasm is suspected and provocative testing may be necessary. (Level of Evidence: C) 6. Patients with a high pretest probability of left main or 3-vessel CAD. (Level of Evidence: C) Class IIb1. Patients with recurrent hospitalization for chest pain in whom a definite diagnosis is judged necessary. (Level of Evidence: C) 2. Patients with an overriding desire for a definitive diagnosis and a greater-than-low probability of CAD. (Level of Evidence: C) Class III1. Patients with significant comorbidity in whom the risk of coronary arteriography outweighs the benefit of the procedure. (Level of Evidence: C) 2. Patients with an overriding personal desire for a definitive diagnosis and a low probability of CAD. (Level of Evidence: C) |
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See Also
Sources
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. 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). Circulation. 2003 Jan 7; 107 (1): 149-58. PMID 12515758
- ↑ Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Gardin JM, O'Rourke RA, Williams SV, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW; American College of Cardiology; American Heart Association; American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. 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. Circulation. 2007 Dec 4; 116 (23): 2762-72. Epub 2007 Nov 12. PMID 17998462