Table 1: Indications for

invasive coronary angiography.

ACS-

STEMI

Angiography and primary angioplasty are recommended over fibrinolysis in patients with < 12 hours of onset of symptoms or in > 12 hours, after fibrinolysis, if symptoms persist, or there are hemodynamic instability or severe arrhythmias

ACS-

NSTEMI

Urgent angiography (< 2 h) is indicated in very high-risk patients. Within 24 hours at high risk: persistent angina, ECG changes or enzyme elevation. In 12-48 h if symptoms persist, or there are severe ischemia or LV dysfunction

CCS

Persistence of symptoms after optimal medical treatment. Severe ischemia unveiled with non-invasive studies, or inconclusive results with a high probability of the disease. Significant high-risk lesions on coronary CT angiography

Direct

Before high-risk heart surgery, or organ transplantation. Prior to surgery for aneurysm or aortic dissection. Hypertrophic cardiomyopathy with angina or Kawasaki disease with documented coronary aneurysms

Indications for invasive coronary angiography:

ACS-STEMI = ST segment elevation

acute coronary syndrome;

ACS-NSTEMI = non-ST segment elevation

acute coronary syndrome;

CCS = chronic coronary syndrome;

EKG = electrocardiogram;

LV = left ventricular.7-9