[Indications for coronary angiography and other special studies]

The prerequisite in establishing the indication for coronary arteriography is low mortality and morbidity of the procedure. Mortality is about 1%, major complications are myocardial infarction (1.5 to 2%) and cerebral embolism (less than 1%). These low complication rates are generally achieved only in institutions which perform at least 400 procedures per year. Coronary arteriography is indicated in the following groups of patients: patients with angina pectoris aged below 45; patients over 45 with sudden worsening of angina, angina pectoris uncontrolled by medication (impaired quality of life) and cases where there is objective evidence of severe ischemia on exercise though angina is mild; recurrence of angina or positive stress ECG after myocardial infarction; following an episode of unstable angina; following resuscitation due to ventricular fibrillation; suspected Prinzmetal angina; postinfarction aneurysm with signs of heart failure; candidates for valve surgery aged over 45. Coronary arteriography is also performed to evaluate the result of bypass surgery, in patients with unclear diagnosis exposed to occupational hazards, and in acute myocardial infarction (thrombolysis, ventricular septal rupture, acute mitral regurgitation). The main indications for radioisotope studies (Tl-201 myocardial scintigraphy and radionuclide angiography during dynamic exercise) are detection and localization of ischemic zones and scars in patients with known coronary disease, and evaluation of the result of coronary artery bypass surgery. Less frequent indications are, today, atypical chest pain and uninterpretable ECG, and asymptomatic patients with abnormal stress ECG. 2-d echocardiography is the most widely used noninvasive technique for qualitative assessment of regional wall motion disorders at rest. 3800 coronary arteriographies are performed yearly in the public hospitals of Switzerland.(ABSTRACT TRUNCATED AT 250 WORDS)