• Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2006 Jan 25 [Various]. [18 references]

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

Coronary heart disease, with or without angina pectoris

Diagnosis
Management

Cardiology
Family Practice
Internal Medicine

Health Care Providers
Physicians

Evidence-Based Medicine Guidelines collects, summarizes, and updates the core clinical knowledge essential in general practice. The guidelines also describe the scientific evidence underlying the given recommendations.

• Patients with angina pectoris
• Patients without angina pectoris in whom angiography may be indicated or considered

Coronary angiography

Not stated

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

The evidence reviewed was collected from the Cochrane database of systematic reviews and the database of abstracts of reviews of effectiveness (DARE). In addition, the Cochrane Library and medical journals were searched specifically for original publications.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

1. Strong research-based evidence. Multiple relevant, high-quality scientific studies with homogenic results.
2. Moderate research-based evidence. At least one relevant, high-quality study or multiple adequate studies.
3. Limited research-based evidence. At least one adequate scientific study.
4. No research-based evidence. Expert panel evaluation of other information.

Review of Published Meta-Analyses
Systematic Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

Aims

• To determine the extent of anatomic coronary artery obstruction when coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) is considered.
• To evaluate difficult diagnostic problems in patients with unstable angina, survival of sudden death, atypical chest pain.

Indications in Patients with Angina Pectoris (AP)

• Severe stable AP resistant to medication
• Occlusion of left anterior descending artery (LAD) or a 3-vessel disease is suspected on the basis of an exercise tolerance test (also when the symptoms are mild)
  • Ischaemic ST (>2 mm) with minimal load and low heart rate
  • Deficient rise in blood pressure (BP) during exercise test
• AP after acute myocardial infarction
  • Pain at rest or when walking while the patient is still in the hospital
  • AP and severe heart failure (myocardial stunning)
  • ST-depression outside the infarction area during exercise
• Unstable AP resistant to medication
• AP following PTCA
• In cases of rapidly recurring AP after CABG, if PTCA may be considered.

Indications in Patients without AP

• Angiography may be indicated or considered:
  • In patients accepted for heart surgery (e.g., valve prosthesis)
  • In survivors of ventricular fibrillation without myocardial infarction (MI)
  • When the exercise electrocardiogram (ECG) changes are clearly pathological
  • In acute pulmonary oedema without evident cause
  • When ECG after a T-wave infarction (non-Q-wave infarction) shows long lasting and wide T inversions in anterior wall leads
  • When MI is diagnosed with biochemical markers while ECG is normal
  • As a diagnostic method in special situations (e.g., when symptoms are atypical, or when left bundle branch block [LBBB] and left ventricular hypertrophy [LVH] disturb the interpretation of the exercise test)

None provided

Concise summaries of scientific evidence attached to the individual guidelines are the unique feature of the Evidence-Based Medicine Guidelines. The evidence summaries allow the clinician to judge how well-founded the treatment recommendations are. The type of supporting evidence is identified and graded for select recommendations (see the "Major Recommendations" field).

Appropriate use of coronary angiography to diagnosis the extent of coronary artery obstruction before coronary bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA)

Not stated

An implementation strategy was not provided.

Getting Better

Effectiveness

• Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2006 Jan 25 [Various]. [18 references]

Not applicable: The guideline was not adapted from another source.

2001 Apr 30 (revised 2006 Jan 25)

Finnish Medical Society Duodecim - Professional Association

Finnish Medical Society Duodecim

Editorial Team of EBM Guidelines

Primary Authors: Editors

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

None available

None available

This summary was completed by ECRI on August 28, 2001. The information was verified by the guideline developer as of October 26, 2001. This summary was updated by ECRI on December 9, 2002. This summary was verified by the developer on April 2, 2003. This summary was updated by ECRI on February 21, 2005, and March 15, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.