How to Weigh Angiogram Benefits and Risks


Getting an angiogram? Make sure your hospital has a cath lab.(LESTER LEFKOWITZ/VEER)

You might receive an angiogram if you have symptoms that worry your doctor—such as chest pain or a heart attack. "The majority of times patients will come in with pain, we do a stress test, and then we go to the angiogram, which is still the gold standard for testing," says Leslie Cho, MD, medical director of Preventive Cardiology and Rehabilitation at the Cleveland Clinic.

Angiograms test for blockages in the coronary arteries in addition to other cardiovascular ailments. The test is often used to diagnose coronary artery disease (CAD) or to track the success of heart treatments. It's also commonly performed on heart attack patients. Angiograms are generally safe, but doctors may elect not to perform the test on patients who are too ill to undergo bypass surgery or angioplasty.

Because coronary angiograms involve inserting a catheter (a thin tube) through an artery in the leg up to the heart, the procedure is usually performed in a hospital, in a cardiac catheterization lab (commonly called a "cath" lab).

Unfortunately, many hospitals—even some large hospitals in urban areas—lack cath labs. If possible, it's a good idea to receive treatment for heart disease at a hospital that has such a facility.

What angiograms can miss in women
Doctors have recently discovered that angiograms may miss an important kind of heart disease called coronary microvascular syndrome. Most common in women, the syndrome causes plaque to spread evenly throughout the wall of the arteries, which may look clear during an angiogram but may still result in heart attack or sudden death.

"There are likely two million to three million women in the U.S. with this disorder, yet most community-based physicians don't know how to test for it or treat it," says Noel Bairey Merz, MD, medical director of the Women's Heart Center at Cedars-Sinai Medical Center.

Dr. Bairey Merz and her colleagues documented the condition in a recent large-scale study of women and heart disease for the National Institutes of Health. Women with this condition, and some men, have ongoing chest pain and usually have abnormal stress tests, but their angiograms may appear normal. Doctors can detect coronary microvascular syndrome if they perform a special type of angiogram, says Dr. Bairey Merz, who is working to develop new noninvasive tests for the syndrome.