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Coronary Artery Disease: Should I Have an Angiogram?
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Coronary Artery Disease: Should I Have an Angiogram?
1Get the |
2Compare |
3Your |
4Get the |
5Quiz |
6Your Summary |
Get the facts
Your options
- Have an angiogram to help decide how best to treat your coronary artery disease.
- Don’t have an angiogram.
This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.
Key points to remember
- An angiogram can show if your coronary arteries are narrowed, where they are narrowed, and by how much. It can help your doctor see if a change in treatment—such as medicines, angioplasty, or coronary artery bypass surgery—can improve your angina or lower your risk of heart attack or death from heart problems.
- An angiogram can’t show if narrowed places in your arteries will cause a heart attack.
- If, during the test, your doctor sees that your arteries are badly narrowed, you may need to have an angioplasty or bypass surgery right away. So before you have the test, it’s a good idea to talk with your doctor about these treatments. Ask what the test might show and what your choices are in each case.
- You may not need an angiogram if you can control your angina symptoms with medicines and are otherwise healthy.
- The test has risks. So you may not want an angiogram if you already know that you don’t want to have angioplasty or bypass surgery.
What is a coronary angiogram?
A coronary angiogram is an X-ray test that takes pictures of the blood flow through your coronary arteries. It helps your doctor see if your arteries are narrowed. It can also show where they are narrowed and by how much.
During the test, a thin tube called a catheter is placed in an artery of your arm or leg. It’s then gently threaded up into your heart. A dye is put through the catheter. The dye helps your doctor see the arteries on the X-ray.
Before the test, you may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb. You may feel a brief sting or pinch from the numbing medicine. Most people do not have pain when the catheter is in the blood vessel. You will probably feel some warmth when the dye is put in.
The procedure will take about 1 to 3 hours. You may be able to go home later the same day. Some people need to stay in the hospital overnight. You will need to do only light activity for a day or two.
What is coronary artery disease?
Coronary artery disease occurs when fatty deposits called plaque (say “plak”) build up inside the coronary arteries. These arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it can narrow the arteries. This may limit how much blood can get to your heart. If the plaque breaks apart, a blood clot could cause a heart attack.
Narrowing of the arteries can lead to symptoms of angina, such as chest pain or pressure and shortness of breath.
Treatment of coronary artery disease helps relieve symptoms. It also can slow how quickly the disease gets worse and can prevent a heart attack. Treatments include medicines, lifestyle changes (such as a heart-healthy diet and physical activity), angioplasty, and coronary artery bypass surgery. Everyone who has heart disease needs to take medicines and have a heart-healthy lifestyle—even if they have angioplasty or surgery.
Why is an angiogram done?
An angiogram can help you and your doctor decide what treatment is best for you.
You may decide to have an angiogram because:
- It can help your doctor see if a change in treatment might lower your risk of heart attack or death from heart problems. An angiogram can show your doctor where plaques have narrowed your arteries and if blood flow is slowed. But it can’t show if these plaques will cause a heart attack.
- You want more relief from your angina. The test can show your doctor if a procedure or surgery could improve your symptoms.
It’s important to talk with your doctor about your angina symptoms. Do your symptoms limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn’t control your symptoms enough. Your doctor may change your dose or suggest a different medicine.
Having the test doesn’t mean that you will have an angioplasty or bypass surgery.
But, if during the angiogram the doctor sees that your arteries are badly narrowed, you may need angioplasty or bypass surgery right away. So before you have an angiogram, you may want to talk with your doctor about these treatments. During the test, you will not be able to decide about more treatment, because you will be sleepy from medicines.
Why might you choose not to have an angiogram?
An angiogram isn’t right for everyone.
- It’s usually not suggested if you have a low risk of a heart attack or you don’t have angina symptoms.
- You probably don’t need the test if you can control your angina with medicines and lifestyle changes.
- You may not need it if other tests (such as a cardiac stress test) gave your doctor enough information to guide your treatment.
- You might choose not to have the test if you already know that you don’t want to have angioplasty or bypass surgery.
What are the risks of an angiogram?
Most people do not have problems during or after an angiogram.
Heart attack and stroke happen rarely, but they can be life-threatening. They are more likely to occur in older people or people who have health conditions that raise the risk of heart attack or stroke.
Other problems that can happen during or soon after an angiogram include:
- A tear or sudden closure in an artery.
- An allergic reaction to the dye used to see the arteries.
- Kidney damage related to the dye.
- Bleeding or bruising where the catheter was put in.
Conditions that can raise risk of problems
Certain health conditions can raise your risk of having problems after angioplasty. Conditions that can raise the risk of death from the procedure include heart failure, heart valve problems, and chronic kidney disease. The risk of heart attack may be higher if you have heart disease in the left main coronary artery.
Having these conditions doesn’t mean that you will have a problem from the procedure. You and your doctor can talk about whether your risk of a problem is higher than average.
Radiation risk
There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this test.
Some evidence suggests that the radiation used in this test could raise the risk of getting cancer later in life. But the risk is believed to be about the same as from many everyday activities and medical procedures. The risk of damage from the X-rays is usually very low compared with the possible benefits of the test.
What do numbers tell us about benefits and risks of an angiogram?
Benefits
The benefits of an angiogram aren’t the kinds of things that can be directly measured by numbers. The main reason to think about having the test is that it can help you and your doctor make better decisions about whether and how to treat your heart disease. In some cases, those treatment decisions can save your life.
Risks
| Problems related to the procedure | Rates in patients |
|---|---|
| Heart attack | 1 to 2 in 1,000 |
| Stroke | 1 to 2 in 1,000 |
| Death | 1 to 2 in 1,000 |
| Heavy bleeding | Fewer than 20 out of 1000 |
*Based on observed rates of complications from patients, not from studies.
Take a group of 1,000 people who have an angiogram. They are at risk for:
- Heart attack: 1 to 2 people out of 1,000 may have a heart attack related to the procedure. This means that 998 to 999 probably won’t.footnote 1, footnote 2
- Stroke: 1 to 2 people out of 1,000 may have a stroke related to the procedure. This means that 998 to 999 probably won’t. footnote 1, footnote 2
- Death: 1 to 2 people out of 1,000 may die as a result of the procedure. This means that 998 to 999 probably won’t.footnote 1, footnote 2
- Heavy bleeding: Fewer than 20 out of 1,000 people will have heavy bleeding from the procedure. This means that at least 980 probably won’t.footnote 3
Compare your options
Compare
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What is usually involved? |
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|---|---|---|
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What are the benefits? |
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What are the risks and side effects? |
- An angiogram takes about 1 to 3 hours. You will get a shot to numb the site where a catheter is placed in your blood vessel.
- After the test, you may need to stay in bed for several hours with your arm or leg straight. You may go home the same day or the next day.
- You make lifestyle changes. These include quitting smoking, eating a heart-healthy diet, and getting regular exercise.
- You take medicines to lower your risk of a heart attack. You also may take medicines to help control angina.
- The test helps you and your doctor decide what treatment will improve your symptoms and lower your risk for a heart attack. Treatments include medicines and lifestyle changes and maybe a procedure or surgery (along with medicines and lifestyle changes).
- An angiogram has some risks. They include:
- Allergic reaction to the dye used to see the coronary arteries.
- Bleeding at the site where the catheter is placed.
- Kidney damage related to the dye.
- Heart attack.
- Stroke.
- Death.
- You try lifestyle changes. These include quitting smoking, eating a heart-healthy diet, and getting regular exercise.
- You may take medicines to lower your chance of a heart attack. These include aspirin and medicines to control your cholesterol and blood pressure.
- You may take medicines to help control angina.
- You may have a test such as a cardiac stress test. It can help your doctor see if you have an increased risk of a heart attack.
- You avoid the cost and risks of an angiogram.
- You may avoid treatments (angioplasty or surgery) that you don’t want.
- You can decide later to have an angiogram.
- Medicines and lifestyle changes may not improve your angina as much as you would like. And there is still a chance you could have a heart attack or stroke.
- If you don’t have an angiogram, you may not get a procedure or surgery that might prevent a heart attack or a stroke.
Personal stories about deciding whether to have an angiogram
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My heart medicine just isn’t working as well as it used to. Although my angina is stable, I am not feeling as well as I’d like to. I want to have the energy to play with my grandkids and the confidence to take the vacations my wife and I always planned. I’ve decided to have an angiogram so that my wife, my doctor, and I can make a decision about whether there may be something else that can help me.
Julian, age 68
I’ve been taking medicines for my angina, but my symptoms are still bothering me on my walks every day. My doctor said that an angiogram could show if an angioplasty could help me feel better. But she also said I could try a different angina medicine first and see if that helped. So I’m going to do that. I can still have the test later.
Reynaldo, age 75
My chest pain is getting so bad that I can’t do my gardening. And that’s my favorite thing to do. So when my doctor recommended an angiogram, I was all for it. I decided I would rather have the test, and then surgery if I need it, so I can feel better and enjoy my life.
Mabel, age 60
I was getting chest pain after I walked a few blocks, or even less if it was cold out. I thought it was just my lungs, but when I saw my doctor, he said he thought it was my heart. So I took a treadmill test. Based on my results, my doctor thought I probably had some narrowing in my heart arteries. But he said it didn’t seem too bad. We decided to try some medicine to see if that helps instead of having that test where they put dye in your arteries. I have been doing well and almost never get chest pain anymore.
Jean, age 62
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have an angiogram
Reasons not to have an angiogram
My angina is affecting my quality of life.
I’m able to control my angina with medicines.
If an artery is badly narrowed, I know I may need emergency angioplasty or surgery.
I already know that I don’t want angioplasty or bypass surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having an angiogram
NOT having an angiogram
What else do you need to make your decision?
Check the facts
Decide what’s next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you’re leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | Robert A. Kloner MD, PhD – Cardiology |
| Primary Medical Reviewer | John B. Wong MD – Internal Medicine |
- Bashore TM, et al. (2012). 2012 ACCF/SCAI Expert consensus document on cardiac catheterization laboratory standards update. Journal of the American College of Cardiology, 59(24): 2221–2305.
- Noto TJ, et al. (1991). Cardiac catheterization 1990: A report of the registry of the Society for Cardiac Angiography and Interventions (SCA&I). Catheterization and Cardiovascular Diagnosis, 24(2): 75–83.
- Arora N, et al. (2007). A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. American Heart Journal, 153(4): 606–611. DOI: 10.1016/j.ahj.2006.12.014.
Coronary Artery Disease: Should I Have an Angiogram?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have an angiogram to help decide how best to treat your coronary artery disease.
- Don’t have an angiogram.
This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.
Key points to remember
- An angiogram can show if your coronary arteries are narrowed, where they are narrowed, and by how much. It can help your doctor see if a change in treatment—such as medicines, angioplasty, or coronary artery bypass surgery—can improve your angina or lower your risk of heart attack or death from heart problems.
- An angiogram can’t show if narrowed places in your arteries will cause a heart attack.
- If, during the test, your doctor sees that your arteries are badly narrowed, you may need to have an angioplasty or bypass surgery right away. So before you have the test, it’s a good idea to talk with your doctor about these treatments. Ask what the test might show and what your choices are in each case.
- You may not need an angiogram if you can control your angina symptoms with medicines and are otherwise healthy.
- The test has risks. So you may not want an angiogram if you already know that you don’t want to have angioplasty or bypass surgery.
What is a coronary angiogram?
A coronary angiogram is an X-ray test that takes pictures of the blood flow through your coronary arteries. It helps your doctor see if your arteries are narrowed. It can also show where they are narrowed and by how much.
During the test, a thin tube called a catheter is placed in an artery of your arm or leg. It’s then gently threaded up into your heart. A dye is put through the catheter. The dye helps your doctor see the arteries on the X-ray.
Before the test, you may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb. You may feel a brief sting or pinch from the numbing medicine. Most people do not have pain when the catheter is in the blood vessel. You will probably feel some warmth when the dye is put in.
The procedure will take about 1 to 3 hours. You may be able to go home later the same day. Some people need to stay in the hospital overnight. You will need to do only light activity for a day or two.
What is coronary artery disease?
Coronary artery disease occurs when fatty deposits called plaque (say “plak”) build up inside the coronary arteries. These arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it can narrow the arteries. This may limit how much blood can get to your heart. If the plaque breaks apart, a blood clot could cause a heart attack.
Narrowing of the arteries can lead to symptoms of angina, such as chest pain or pressure and shortness of breath.
Treatment of coronary artery disease helps relieve symptoms. It also can slow how quickly the disease gets worse and can prevent a heart attack. Treatments include medicines, lifestyle changes (such as a heart-healthy diet and physical activity), angioplasty, and coronary artery bypass surgery. Everyone who has heart disease needs to take medicines and have a heart-healthy lifestyle—even if they have angioplasty or surgery.
Why is an angiogram done?
An angiogram can help you and your doctor decide what treatment is best for you.
You may decide to have an angiogram because:
- It can help your doctor see if a change in treatment might lower your risk of heart attack or death from heart problems. An angiogram can show your doctor where plaques have narrowed your arteries and if blood flow is slowed. But it can’t show if these plaques will cause a heart attack.
- You want more relief from your angina. The test can show your doctor if a procedure or surgery could improve your symptoms.
It’s important to talk with your doctor about your angina symptoms. Do your symptoms limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn’t control your symptoms enough. Your doctor may change your dose or suggest a different medicine.
Having the test doesn’t mean that you will have an angioplasty or bypass surgery.
But, if during the angiogram the doctor sees that your arteries are badly narrowed, you may need angioplasty or bypass surgery right away. So before you have an angiogram, you may want to talk with your doctor about these treatments. During the test, you will not be able to decide about more treatment, because you will be sleepy from medicines.
Why might you choose not to have an angiogram?
An angiogram isn’t right for everyone.
- It’s usually not suggested if you have a low risk of a heart attack or you don’t have angina symptoms.
- You probably don’t need the test if you can control your angina with medicines and lifestyle changes.
- You may not need it if other tests (such as a cardiac stress test) gave your doctor enough information to guide your treatment.
- You might choose not to have the test if you already know that you don’t want to have angioplasty or bypass surgery.
What are the risks of an angiogram?
Most people do not have problems during or after an angiogram.
Heart attack and stroke happen rarely, but they can be life-threatening. They are more likely to occur in older people or people who have health conditions that raise the risk of heart attack or stroke.
Other problems that can happen during or soon after an angiogram include:
- A tear or sudden closure in an artery.
- An allergic reaction to the dye used to see the arteries.
- Kidney damage related to the dye.
- Bleeding or bruising where the catheter was put in.
Conditions that can raise risk of problems
Certain health conditions can raise your risk of having problems after angioplasty. Conditions that can raise the risk of death from the procedure include heart failure, heart valve problems, and chronic kidney disease. The risk of heart attack may be higher if you have heart disease in the left main coronary artery.
Having these conditions doesn’t mean that you will have a problem from the procedure. You and your doctor can talk about whether your risk of a problem is higher than average.
Radiation risk
There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this test.
Some evidence suggests that the radiation used in this test could raise the risk of getting cancer later in life. But the risk is believed to be about the same as from many everyday activities and medical procedures. The risk of damage from the X-rays is usually very low compared with the possible benefits of the test.
What do numbers tell us about benefits and risks of an angiogram?
Benefits
The benefits of an angiogram aren’t the kinds of things that can be directly measured by numbers. The main reason to think about having the test is that it can help you and your doctor make better decisions about whether and how to treat your heart disease. In some cases, those treatment decisions can save your life.
Risks
| Problems related to the procedure | Rates in patients |
|---|---|
| Heart attack | 1 to 2 in 1,000 |
| Stroke | 1 to 2 in 1,000 |
| Death | 1 to 2 in 1,000 |
| Heavy bleeding | Fewer than 20 out of 1000 |
*Based on observed rates of complications from patients, not from studies.
Take a group of 1,000 people who have an angiogram . They are at risk for:
- Heart attack: 1 to 2 people out of 1,000 may have a heart attack related to the procedure. This means that 998 to 999 probably won’t.1, 2
- Stroke: 1 to 2 people out of 1,000 may have a stroke related to the procedure. This means that 998 to 999 probably won’t. 1, 2
- Death: 1 to 2 people out of 1,000 may die as a result of the procedure. This means that 998 to 999 probably won’t.1, 2
- Heavy bleeding: Fewer than 20 out of 1,000 people will have heavy bleeding from the procedure. This means that at least 980 probably won’t.3
2. Compare your options
| Have an angiogram | Don’t have an angiogram | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about deciding whether to have an angiogram
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
“My heart medicine just isn’t working as well as it used to. Although my angina is stable, I am not feeling as well as I’d like to. I want to have the energy to play with my grandkids and the confidence to take the vacations my wife and I always planned. I’ve decided to have an angiogram so that my wife, my doctor, and I can make a decision about whether there may be something else that can help me.”
— Julian, age 68
“I’ve been taking medicines for my angina, but my symptoms are still bothering me on my walks every day. My doctor said that an angiogram could show if an angioplasty could help me feel better. But she also said I could try a different angina medicine first and see if that helped. So I’m going to do that. I can still have the test later.”
— Reynaldo, age 75
“My chest pain is getting so bad that I can’t do my gardening. And that’s my favorite thing to do. So when my doctor recommended an angiogram, I was all for it. I decided I would rather have the test, and then surgery if I need it, so I can feel better and enjoy my life.”
— Mabel, age 60
“I was getting chest pain after I walked a few blocks, or even less if it was cold out. I thought it was just my lungs, but when I saw my doctor, he said he thought it was my heart. So I took a treadmill test. Based on my results, my doctor thought I probably had some narrowing in my heart arteries. But he said it didn’t seem too bad. We decided to try some medicine to see if that helps instead of having that test where they put dye in your arteries. I have been doing well and almost never get chest pain anymore.”
— Jean, age 62
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have an angiogram
Reasons not to have an angiogram
My angina is affecting my quality of life.
I’m able to control my angina with medicines.
If an artery is badly narrowed, I know I may need emergency angioplasty or surgery.
I already know that I don’t want angioplasty or bypass surgery.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having an angiogram
NOT having an angiogram
5. What else do you need to make your decision?
Check the facts
1. An angiogram can help me and my doctor decide which treatment is best for my heart disease.
- True
- False
- I’m not sure
2. I may not need an angiogram if I can control my angina symptoms with medicines and I’m otherwise healthy.
- True
- False
- I’m not sure
3. An angiogram can tell if I’m going to have a heart attack.
- True
- False
- I’m not sure
Decide what’s next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I’m ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | Robert A. Kloner MD, PhD – Cardiology |
| Primary Medical Reviewer | John B. Wong MD – Internal Medicine |
- Bashore TM, et al. (2012). 2012 ACCF/SCAI Expert consensus document on cardiac catheterization laboratory standards update. Journal of the American College of Cardiology, 59(24): 2221–2305.
- Noto TJ, et al. (1991). Cardiac catheterization 1990: A report of the registry of the Society for Cardiac Angiography and Interventions (SCA&I). Catheterization and Cardiovascular Diagnosis, 24(2): 75–83.
- Arora N, et al. (2007). A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. American Heart Journal, 153(4): 606–611. DOI: 10.1016/j.ahj.2006.12.014.
Note: The “printer friendly” document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: April 9, 2019
Author: Healthwise Staff
Medical Review:Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology & Martin J. Gabica MD – Family Medicine & Adam Husney MD – Family Medicine & Robert A. Kloner MD, PhD – Cardiology & John B. Wong MD – Internal Medicine