Coronary angiography

Coronary angiography detects the location and degree of coronary atherosclerosis and is used to evaluate the potential benefit from revascularization procedures. Stenosis of at least 70% of the diameter of at least one of the major epicardial arteries on coronary angiography is indicative of significant IHD. 

When drug therapy fails or if extensive coronary atherosclerosis is present, PCI is often performed to restore coronary blood flow, relieve symptoms, and prevent major adverse cardiac events. Patients with one or more critical coronary stenoses (i.e., greater than 70% occlusion of the coronary lumen) detected during coronary angiography may be candidates for PCI. Several catheter-based interventions maybe used during PCI, including ... 

Because reinfarction and death are major outcomes following ACS, therapeutic strategies to reduce morbidity and mortality, particularly utilization of coronary angiography, revascularization, and pharmacotherapy, will have a significant impact on the social and economic burden of CHD in the United States. 

Patient symptoms, past medical history, ECG, and troponin or CK-MB determinations are used to stratify patients into low, medium, or high risk of death or MI or likelihood of needing urgent coronary angiography and percutaneous coronary intervention (PCI). 

High-risk NSTE ACS patients should undergo early coronary angiography (within 24 to 48 hours) and revascularization if a significant coronary artery stenosis is found. Moderate-risk patients with positive biochemical... 

Cardiac catheterization and coronary angiography are used in patients with suspected CAD to document the presence and severity of disease as well as for prognostic purposes. Interventional catheterization is used for thrombolytic therapy in patients with acute MI and for managing patients with significant CAD to relieve obstruction through percutaneous transluminal coronary angioplasty, atherectomy, laser treatment, or stent placement. 

L3. Labeur, C., De Bacquer, D., De Backer, G., Vincke, J., Muyldermans, L., Vandekerckhove, Y., Vander Stichele, E., and Rosseneu, M., Plasma lipoprotein(a) values and the severity of coronary heart disease in a large population of patients undergoing coronary angiography. Clin. Chem. (Winston-Salem, NC) 38, 2261-2266 (1992). 

Allergic reactions Approximately 53% of all allergic reactions or suspected allergic reactions occurred in patients who concomitantly received thrombolytic therapy (eg, streptokinase) for acute Ml or contrast media for coronary angiography (see Adverse Reactions). 

Sones EM. Cine coronary angiography. Mod Concepts Cardiovasc Dis 1962 31 735-738. 

A 60-year-old man comes into the office complaining of chest pains that primarily occur in the early morning and do not appear to be associated with stress or exercise. Following coronary angiography and a positive ergonovine test you determine that this patient has angina pectoris as a result of coronary artery spasm. How would you (1) treat the patient to alleviate the acute attacks when they occur and (2) treat chronically to prevent their reoccurrence ... 

Ergonovine given intravenously produces prompt vasoconstriction during coronary angiography to diagnose variant angina if reactive segments of the coronaries are present. 

A 32-year-old woman, a smoker, had an evacuation after the death of her fetus at 18 weeks. Two pessaries of gemeprost 1 mg were inserted 7.25 hours apart, and about 90 minutes later she became unconscious, apneic, and cyanotic, and had dilated pupils and no detectable blood pressure or pulse. She was given 100% oxygen, intravenous adrenaline and dobutamine, and a crystalloid infusion. Her systolic pressure rose to 100 mmHg. Coronary angiography showed left and circumflex coronary artery spasm. 

A 58-year-old man with a previous smoking history and a history of hypertension was severely biochemically hypothyroid (serum TSH 221 mU/1) and was given thyroxine, initially in a low dose (25 micrograms/day), increasing to 100 micrograms/day after 2 weeks. A month later he sustained a subendocardial myocardial infarction associated with only minor abnormalities on coronary angiography. 

A 61-year-old woman with severe hypothyroidism (serum TSH 115 mU/1) had an acute myocardial infarction (but no demonstrable abnormality on coronary angiography) 1 month after a thyroxine dosage increase from 50 to 100 micrograms/day. 

Koronarangiographie—eine prospektive Untersuchung euthyreoten Patienten. [Thyroid function after iodine-containing contrast agent administration in coronary angiography a prospective study of euthyroid patients.] Z Kardiol 2001 90(10) 751-9. 

Ergonovine produces prompt vasoconstriction during coronary angiography to diagnose variant angina. 

In Table 4, we can see quantitative coronary angiography data of the 85 lesions with follow-up angiography. At follow-up, the minimum luminal diameter (MLD) of lesions in patients with a high rapamycin blood concentration was... 

Table 4 Baseline and follow-up quantitative coronary angiography data ...

I I Auer J, Rammer M, Berent R, et al. Body iron stores and coronary atherosclerosis assessed by coronary angiography. Nutr Metab Cardiovasc Dis 2002 12(5) 285-290. 

Kwok OH, Chow WH, Law TC, et al. First human experience with angiopeptin-eluting stent a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Catheter Cardiovasc Interv2005 66(4) 54l-546. Nakamura M, Wada M, Hara H, et al. Angiographic and clinical outcomes of a pharmacokinetic study of sirolimus-eluting stents lesson from restenosis cases. Circ J 2005 69(10) ... 

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