Diagnostic coronary angiography – Related resources
03.06.2016 • Sonuncu dəyişiklik 28.07.2014
This article is created and updated by the EBMG Editorial Team
Cochrane reviews
CABG may be superior to PTCA in terms of morbidity outcome and similar in terms of mortality. CABG patients may be less likely to need re-intervention than those treated using angioplasty with stents .
GP IIb/IIIa blockers reduce the risk of death at 30 days and the risk of death or MI at 30 days and 6 months in patients submitted to percutaneous coronary angioplasty, at a price of an increase in the risk of severe bleeding. For patients with unstable angina or non-ST-segment elevation infarction, there is only slight advantage in the reduction of death or MI, but no reduction in mortality .
Ticlodipine plus aspirin is more effective than oral anticoagulation in preventing coronary events in patients undergoing coronary stenting, but adverse effects limit its use .Intravenous pain regimens (opioid and anxiolytic) and subcutaneous levobupivacaine appear to produce small reductions in pain score related to femoral sheath removal, but subcutaneous lignocaine is probably not effective .
Other evidence summaries
A strategy of initial CABG is associated with lower mortality and lower rate of myocardial infarction than a strategy of medical management alone (with delayed surgery if necessary) in high-risk and medium-risk patients with stable coronary disease .
Patients with moderate to severe left ventricular systolic dysfunction and concomitant limiting angina may have improved survival and physical functioning after CABG .
The medium and long-term outcomes after balloon angioplasty may be favourable with a low mortality and myocardial infarction rate and a low rate of later restenosis (after 6 months) .
PTCA may lead to greater reduction in angina, but there is no evidence of improved survival or reduction of subsequent revascularization, though trends do not favour angioplasty.
Clinical guidelines
- European Association for Percutaneous Cardiovascular Interventions, Wijns W, Kolh P et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010;31(20):2501-55.
Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, Fox KA, Hasdai D, Ohman EM, Wallentin L, Wijns W. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007 Jul;28(13):1598-660. .
- Hamm CW, Bassand JP, Agewall S et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23):2999-3054.
- Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569-619.
Van de Werf F, Bax J, Betriu A et al, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M, ESC Committee for Practice Guidelines (CPG), Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Silber S, Aguirre FV, Al-Attar N, Alegria E, Andreotti F, Benzer W, Breithardt O, Danchin N, Di Mario C, Dudek D, Gulba D, Halvorsen S, Kaufmann P, Kornowski R, Lip GY, Rutten F. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008 Dec;29(23):2909-45.
Literature
- Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J 2009 Jan;157(1):132-40.
- Hamon M, Biondi-Zoccai GG, Malagutti P, Agostoni P, Morello R, Valgimigli M, Hamon M. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol 2006 Nov 7;48(9):1896-910.
- Hamon M, Morello R, Riddell JW, Hamon M. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography--meta-analysis. Radiology 2007 Dec;245(3):720-31.
- Ibañez B, Badimon JJ, Garcia MJ. Diagnosis of atherosclerosis by imaging. Am J Med 2009 Jan;122(1 Suppl):S15-25.