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Medical Author:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• What is coronary artery disease?
• What is the purpose of screening tests for CAD?
• What are common initial screening tests for CAD?
• EKG (Electrocardiogram)
• Exercise cardiac stress test (treadmill stress test or ECST)
• Radionuclide stress test
• Stress echocardiography
• Pharmacologic stress test
• Are there other tests for CAD that are noninvasive?
• What is the most accurate method of defining CAD?
• Coronary angiography
• Conclusions
• Find a local Cardiologist in your town
• Coronary Artery Disease Screening Tests (CAD) Index

What is the most accurate method of defining CAD?

The "gold standard" for the evaluation of CAD remains the coronary angiogram. Coronary angiography can be used to identify the exact location and severity of CAD; it is described below.

Coronary angiography

During a coronary angiogram (also termed a coronary catheterization), a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery usually in either the groin or the arm. Guided with the assistance of a fluoroscope (a special X-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with X-ray images) is injected into each coronary artery. The images that are produced are called the angiogram.

Angiographic images accurately reveal the extent and severity of all coronary arterial blockages. Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. The procedure takes approximately 20 to 30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is sutured, "sealed," or treated with manual compression to prevent bleeding. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of experienced physicians, this risk is quite small (well below one per cent). In appropriate patients, the therapeutic information learned from the angiogram is far more valuable than the relatively small risk of the procedure.

For patients with severe angina or heart attack (myocardial infarction), or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stent placement, or coronary bypass surgery. The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions.