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Invasive coronary angiography (CA) remains the standard for identifying coronary artery narrowings related to coronary artery disease (CAD). Selective CA, which was first performed by F. Mason Sones in 1959, enables correlation of different clinical syndromes and electrocardiography (ECG) findings with coronary artery anatomy. The method provides the most reliable information for determining appropriate therapy in patients with CAD. CA has become a routine procedure performed on an ambulatory basis in many centers. Technical and logistic improvements have improved patient safety.

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The physical requirements for invasive CA performed in a catheterization laboratory include a radiographic system, equipment for physiologic data monitoring and acquisition instrumentation, and equipment for emergency patient care. High-resolution x-ray imaging is required for optimal visualization of the coronary tree, including arterial side branches. Traditional film-based cineangiography has in large part been replaced by digital technology. The digital technique enables immediate online review, quantitative computer analysis, image manipulation capabilities, and increased storage capabilities. During the last few years, direct digital imaging with flat panel technique has become the standard in many catheterization laboratories.

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Technique

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Angiography is performed under local anesthesia with small-diameter catheters introduced through a transarterial sheath. The outer diameter of the catheter is specified using French units, where one French unit (F) = 0.33 mm. Normally, 4- or 5-F catheters are used for diagnostic purposes. In the majority of cases, either the femoral or the radial route is used. Through the catheters, which are introduced over a guide wire, iodinated contrast media is injected selectively into the left and right coronary arteries. A few angiographic projections (varying degrees of left, right, cranial, and caudal angulation) are used to enable visualization of the whole coronary tree without superimposition of multiple vessels.

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CA is used to establish or rule out the presence of coronary stenoses, define therapeutic options, and determine prognosis. CA is also used as a research tool for follow-up after invasive procedures or pharmacologic therapy. The American College of Cardiology/American Heart Association (ACC/AHA) Task Force and the European Society of Cardiology established the indications for CA.1,2 Patients with suspected CAD who have severe stable symptoms and those with certain high-risk features for an adverse outcome should have CA. High-risk criteria include low ejection fraction and poor exercise capacity on an exercise test.

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In patients with non–ST-segment elevation acute coronary syndromes (unstable angina and myocardial infarction) with high-risk features (eg, ongoing ischemia, heart failure), CA is recommended during the hospitalization.3,4 In patients with acute ST-segment elevation myocardial infarction (STEMI), guidelines recommend CA in the acute phase for most patients.5,6 Primary percutaneous intervention (PCI) is usually performed in the same procedure, immediately after the diagnostic CA, in these patients.

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There are no absolute contraindications for CA. Relative contraindications include febrile untreated infection, severe anemia, severe electrolyte imbalance, active bleeding, acute renal failure, and ongoing stroke. Risk ...

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