Guideline:
Diagnostic coronary angiography
Bibliographic Source(s)
- Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2008 Apr 30 [Various].
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: 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]
Guideline Category
Diagnosis
Evaluation
Intended Users
Health Care Providers
Physicians
Guideline Objective(s)
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.
Target Population
Patients with coronary heart disease
Interventions and Practices Considered
Coronary angiography
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
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.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Classification of the Quality of Evidence
| Code | Quality of Evidence | Definition |
|---|---|---|
| A | High | Further research is very unlikely to change our confidence in the estimate of effect.
|
| B | Moderate | Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.
|
| C | Low | Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.
|
| D | Very Low | Any estimate of effect is very uncertain.
|
GRADE (Grading of Recommendations Assessment Development and Evaluation) Working Group 2007 (modified by the EBM Guidelines Editorial Team).
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Not stated
Major Recommendations
Principles
- Coronary angiography is used to investigate the anatomy of the coronary arteries and to assess the number location and severity of possible coronary stenoses.
- In the case that a significant stenosis is found it is possible at the same time to perform a therapeutic intervention (i.e. balloon angioplasty and if needed insertion of a metal mesh [stent] to secure the patency of the vessel).
Indications
Angina Pectoris or Other Symptom Triggered by Exertion
- Symptoms that are constant or disturb everyday life despite optimal medication in patients with probable coronary heart disease or with exacerbating symptoms of an earlier established disease
- ST segment depression >1.5 to 2 mm appearing at low workload and/or low rate-pressure product in exercise stress test (see the Finnish Medical Society Duodecim guideline "Exercise Stress Test") suggesting a significant myocardial ischaemia
- Diagnostic work-up of unexplained chest pain when exercise stress test does not establish the diagnosis and the probability of coronary heart disease is increased
- Significant perfusion defect in myocardial perfusion scan or findings in exercise echocardiography indicating myocardial ischaemia
Acute Chest Pain
- ST elevation myocardial infarction (STEMI [see the Finnish Medical Society Duodecim guideline "Thrombolytic Therapy and Balloon Angioplasty in Acute ST Elevation Myocardial Infarction]): coronary angiography should be performed as soon as possible; thrombolytic therapy is an alternative
- Non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris: if signs of high risk are present coronary angiography is performed according to the clinical situation nonetheless within 24 to 48 hours (see the Finnish Medical Society guidelines "Acute Coronary Syndromes: Unstable Angina Pectoris and Non-ST Segment Elevation Myocardial Infarction [NSTEMI]" and "Coronary Heart Disease [CHD]: Symptoms Diagnosis and Treatment").
Other Indications
- Heart failure of unknown aetiology: search for the cause
- As further investigation in a patient surviving resuscitation after ventricular fibrillation
- In association with invasive assessment of a valvular heart disease
- Assessment prior to heart transplantation
Contraindications
- Relative contraindications include
- Severe infection sepsis
- Recent neurological event
- Significant haemorrhagic diathesis
- Severe renal failure
- Allergy to contrast media
Related Resources
Refer to the original guideline document for related evidence including Cochrane reviews and other evidence summaries.
Definitions:
Classification of the Quality of Evidence
| Code | Quality of Evidence | Definition |
|---|---|---|
| A | High | Further research is very unlikely to change our confidence in the estimate of effect.
|
| B | Moderate | Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.
|
| C | Low | Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.
|
| D | Very Low | Any estimate of effect is very uncertain.
|
GRADE (Grading of Recommendations Assessment Development and Evaluation) Working Group 2007 (modified by the EBM Guidelines Editorial Team).
Clinical Algorithm(s)
None provided
Type of Evidence supporting the Recommendations
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.
Potential Benefits
Appropriate use of coronary angiography
Potential Harms
Not stated
Contraindications
Relative contraindications to diagnostic coronary angiography include:
- Severe infection sepsis
- Recent neurological event
- Significant haemorrhagic diathesis
- Severe renal failure
- Allergy to contrast media
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Bibliographic Source(s)
- Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2008 Apr 30 [Various].
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Finnish Medical Society Duodecim
Guideline Committee
Editorial Team of EBM Guidelines
Composition of Group that Authored the Guideline
Primary Authors: Editors
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: 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]
Guideline Availability
This guideline is included in "EBM Guidelines. Evidence-Based Medicine" available from Duodecim Medical Publications Ltd PO Box 713 00101 Helsinki Finland; e-mail: info@ebm-guidelines.com; Web site: www.ebm-guidelines.com.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
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 summary was updated by ECRI Institute on September30 2008.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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