Coronary Angiography:   Coronary angiography is often recommended when the cardiologist suspects a blockage in one or more of your coronary arteries which may be compromising your health.  The doctor determines this by your symptoms, as well as by the results of other diagnostic tests such as ECGs, echocardiograms, and/or stress testing if indicated.  The advantage of coronary angiography is that it allows for direct visualization of the arteries of the heart, as well as visualization of the main heart pumping chamber.  It can also be used to assess the significance of heart valve narrowing or leakage if the physician feels you may need heart valve surgery.

Because coronary angiography involves placing a catheter into the heart and injecting x-ray dye, there are some risks associated with the procedure.  For most people, those risks include less than 0.1% risk of a heart attack, stroke, major rhythm disturbances, death, or dye reaction.  There is also a 1 or 2% risk of such occurrences as nerve damage to the extremity, bleeding or tearing of the artery that the doctor uses to pass the catheter (typically a groin or wrist artery is used).  If this occurs, the assistance of a vascular surgeon may be required.  Additionally, for people with kidney impairment, there is also a risk of further kidney compromise as a result of the procedure due to the dye being used.

A consent must be signed prior to having coronary angiography performed.  If you refuse the test, the physician will continue to treat you with whatever medications he deems necessary.

Coronary Intervention:  Coronary intervention typically involves the restoration of blood flow through a coronary artery by balloon dilatation (angioplasty) followed by the placement of one or more stents to the site to maintain patency.   This procedure may be recommended by your cardiologist if your angiogram demonstrates one or more flow limiting blockages.  The interventional cardiologist will review your angiogram film and determine whether or not your blockages can be corrected with this procedure.  If he does not feel that you are a candidate for this procedure, he may recommend either coronary artery bypass surgery or continued medical therapy.   

If you choose to proceed with coronary intervention, your doctor will inform you of the risks involved.  For most individuals, those risks include a 1-2% risk of a heart attack, 1 in 500 risk of stroke, and less than 5% risk of requiring emergency bypass surgery if the coronary artery should tear.    There is also a less than 1% risk of death, major rhythm disturbances, peripheral nerve damage, requirement of a blood transfusion, or emergent placement of an intra-aortic balloon pump if you should become unstable.    There is also a less than 1% risk of a tear in the artery of the extremity used for access. 

Because of these risks, you are required to sign several consents, including consents for the intervention, consents for coronary artery bypass surgery, consent for blood transfusion, and consent for the placement of an intra-aortic balloon pump. 

Lastly, despite coronary intervention, your risk of developing reocclusion (or restenosis) of that artery in the first one to six months is 15 to 20%.  That risk doubles for diabetic patients.  Because of this risk, you will be recommended nuclear stress testing at one month and six month intervals post-intervention.  Thereafter you will be recommended annual stress tests to assess for artery patency unless you develop symptoms in the interim.