Coronary angiogram
This is the most important test to which a patient with cardiac disease can be subjected. Currently the risks of angiography are minimal. Coronary angiogram is expected to document not only the presence of blockage in the coronary artery but it also documents the location, severity and type of the blockage and provide guidance regarding the modality of treatment e.g. drugs only, balloon treatment or by-pass operation. Coronary angiogram is a invasive test and carries a little risk but it is regarded as the gold standard for the diagnosis of block in the coronary artery. The procedure is very simple but this test can only be done in a cardiac catheterization laboratory. This test is not possible in an ordinary hospital operation theater. The procedure is carried out under local anesthesia, either through groin (upper part of thigh) or through arm. The test is performed using special plastic tubes called catheters. These catheters are introduced inside the arteries through a small needle puncture and general anesthesia is not required. The patient only feels pain during giving local anesthesia and during needle prick. When the catheters are moved and manipulated in the blood vessels and the heart, the patient will not experience pain. The catheters are advanced through the puncture site to the origin of the coronary arteries supplying the heart. After cannulation special dye (contrast media) are injected inside the coronary arteries by hand injection. Multiple pictures of the coronary arteries are taken during injection of dye in side coronaries. Coronary blockages are not visible in conventional X-ray films and only it can be seen during dye injection. All the three arteries (left anterior descending artery, LAD; Left circumflex, LCX and right coronary artery, RCA) can be visualized during coronary angiogram. Before coronary angiogram doctors always remain in doubt regarding the appropriate type of treatment required by the patient. The information from the angiogram would allow the selection of the best form of treatment for the patient, be it medical, balloon angioplasty (PTCA) or coronary by-pass operation.
The risk of coronary angiogram is very minimum and no question of being afraid. Patient remains in full sense during the procedure and the patient can talk with his cardiologist during the test and can see the angiogram procedure in television screen during the procedure. The whole test is usually completed within 15 to 30 minutes. The patient can be discharged from the hospital after 24 hours of the procedure. Now a day’s coronary angiogram are carried out on an outpatient basis and no need for hospital admission. Being a invasive procedure there are some risk inherent in the procedure. The risk of death is about 2 in 1000 procedures, myocardial infarction (heart attack) 1 in 200, stroke 1 in 200, ventricular arrhythmias (irregularities of heart beat) 1 in 100 and blood vessel complications e.g. thrombosis, bleeding etc 1 in 100 cases.
Risks of coronary angiogram
Complications Percentage
Death 0.11%
Myocardial infarction (heart attack) 0.05%
Cerebrovascular accident (stroke) 0.07%
Arrhythmia 0.38%
Vascular complications 0.43%
Contrast reaction 0.37%
Heaenodynamic complications 0.26%
Perforation of heart 0.03%
Other complications 0.28%
Total of major complications 1.70%
[ Modified from ACC/AHA guidelines for Coronary angiography J Am Coll Cardiol 199; 33(6) : P-1760]
The skill and experience of the operator, the catheterization laboratory staff, and the preprocedure and post procedure staff are also important factors in reducing complications. Operator experience is clearly related to lower complication rates. This fact has led American College of Cardiology to recommend a minimum operator volume of 150 diagnostic catheterization per year. This is also true for coronary angioplasty facilities. Recent studies have suggested that laboratory volumes of >200 angioplasty cases per year and 75 cases per operator are necessary to minimize complications and maximize success.
