Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women
Background: Using Coronary Angiography To Diagnose Coronary Artery Disease
Coronary angiography is currently the reference standard for the clinical care of patients who have chest pain suggestive of coronary artery disease (CAD). This technique consists of inserting a catheter into the femoral, brachial, or radial artery, passing it up through the aorta to directly engage the right and left coronary arteries, and injecting an iodinated contrast agent into each artery while capturing digital x-ray images.
The advantages of using coronary angiography include the ability to:
- Visualize the coronary arteries anatomically at high resolution, enabling the identification of luminal obstruction
- Combine diagnosis and treatment in one step
The drawbacks of coronary angiography include:
- The invasive nature of the procedure
- The ability to perform only anatomical, but not functional, assessment of coronary disease
While a coronary lesion might appear significantly obstructive, it may not affect downstream myocardial performance or vice versa. It is therefore important to assess the functional effects of coronary disease using techniques that assess coronary circulation and left ventricular function during exercise or pharmacological stress and in the absence of these stressors
- The risk of bleeding at the access site, or the rare risk of causing injury to the coronary artery due to coronary dissection
- The possibility that anaphylaxis or renal impairment might occur due to an adverse reaction to the contrast agent
- The risk of radiation exposure from imaging, which is of particular concern in women of child-bearing age
Coronary angiography is therefore mainly indicated in patients with chest pain and a high (>90 percent) risk of CAD.
- Dolor RJ, Patel MR, Melloni C, et al. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Comparative Effectiveness Review No. 58 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10061-I). Rockville, MD: Agency for Healthcare Research and Quality; June 2012. AHRQ Publication No. 12-EHC034-EF. Available at www.effectivehealthcare.ahrq.gov/diagnosecad.cfm.
- Matchar DB, Mark DB, Patel MR, et al. noninvasive Imaging for Coronary Artery Disease. Technology Assessment (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025). Rockville, MD: Agency for Healthcare Research and Quality; October 2006. Available at www.cms.gov/determinationprocess/downloads/id34TA.pdf.
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