[Coronary angiography my false friend].

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Coronary angiography, first performed in 1958, is a cornerstone in diagnosing and treating ischemic heart disease, with over 400,000 procedures annually in France.
• Despite advancements in imaging and simplification of techniques, coronary angiography is invasive, involves radiation, and uses potentially nephrotoxic contrast agents.
• It provides a 2D projection of dynamic coronary arteries, requiring technical perfection and careful analysis to mitigate inherent limitations.

Purpose of the Study:

• To review the current role and limitations of coronary angiography in the diagnosis and treatment of coronary artery disease.
• To highlight the importance of complementary functional (FFR, IMR) and morphological (IVUS, OCT) techniques in interpreting angiographic findings.
• To assess the place of coronary angiography in relation to emerging non-invasive methods like coroscanner.

Main Methods:

• Review of historical development and current practices of coronary angiography.
• Discussion of imaging advancements and technical considerations.
• Analysis of limitations and the role of adjunctive diagnostic tools.

Main Results:

• Coronary angiography, while invasive, offers crucial diagnostic and interventional capabilities for coronary artery disease.
• Complementary techniques like FFR, IMR, IVUS, and OCT are vital for resolving ambiguities and guiding treatment decisions.
• Non-invasive methods like coroscanner have limitations (resolution, calcification artifacts) that often necessitate angiography.

Conclusions:

• Coronary angiography remains indispensable for diagnosing coronary artery disease and guiding revascularization strategies.
• Awareness of its pitfalls and integration with complementary functional and morphological assessments are critical for optimal patient care.
• Despite ongoing development of non-invasive alternatives, coronary angiography's established role persists due to its comprehensive diagnostic and therapeutic utility.