Coronary Artery Disease Screening Tests (CAD) (cont.)
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.
Coronary Angiography
During a coronary angiogram, a small catheter (a thin hollow tube
with a diameter of 2-3 mm) is inserted through the skin into an
artery 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 20-30 minutes. After the procedure, the catheter is
removed and the artery in the leg or arm is either 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 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 stenting, atherectomy
("roto-rooter"), 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.
Summary
For the purpose of screening for CAD, each patient should discuss
their particular CAD "risk factor profile" with the doctor in order
to decide if screening tests are indicated and which test is most
appropriate. The doctor will have detailed information regarding what
testing involves and the implications of the results for each
individual.
Last Editorial Review: 10/2/2005
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