Recent advances in Medical Science and the thechnological improvements in the field of myocardial revascularisation, in surgical procedures and in percutaneous interventions, made attractive the initial option for invasive strategies in the management of coronary heart disease. For this reason, coronary arteriography is nowadays more often indicated. Some concepts in coronary heart disease have been reviewed, specially those related to acute coronary syndromes. Non-ST-segment elevation myocardial infarction (previously called non-Q wave myocardial infarction) and unstable angina are now considered "unstable acute coronary syndromes" and both have the same guidelines for management. The main indications for coronary arteriography as the first diagnostic tool are: 1) incapacitating angina, even in stable patients; 2) high-risk patients with unstable coronary syndromes (refractory angina, troponin elevation, new ST- segment deviations, cardiac failure and serious arrythmias); 3) patients with acute ST-elevation myocardial infarction that will be submitted to primary angioplasty or with hemodynamic instability or persistent ischemia. Low-risk patients (angina that promptly subsides after medication, no electrocardiographic or laboratorial changes or atypical chest pain) may be submitted to non-invasive testing for further risk stratification; if no ischemia is detected, coronary arteriography is not indicated and optimized medical treatment is perfectly admitted for a great number of patients. The indications of coronary arteriography for the diagnosis and prognosis of coronary heart disease are not well delimited in clinical practice, and this method is frequently used as the first tool in the investigation of chest pain, even when the characteristics of pain are not exactly those of angina. In this review, the authors discuss the main indications of coronary arteriography in the multiple clinical aspects of coronary heart disease and in the differential diagnosis of chest pain.
Coronary heart disease; Diagnosis; Coronary angiography
