Unstable angina / non ST elevation myocardial infarction coronary angiography


 * Associate Editors-In-Chief: ; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Coronary Angiography in Unstable angina / NSTEMI
One other image modality that can be used in diagnosing and treating UA / NSTEMI is CT coronary angiography. This is a superior imaging technique with a sensitivity and specificity of 90% and 95% respectively. If there is no evidence of either calcified or noncalcified plaque on coronary angiogram, then it is highly unlikely that the patient’s symptoms are due to UA/NSTEMI.

Indications
CT coronary angiography may be appropriate in:
 * evaluation of obstructive coronary artery disease in symptomatic patients (class IIa).
 * patients with acute chest pain with intermediate and possibly low pretest probability of CAD when serial ECG and cardiac biomarkers are negative.

Coronary angiography timing
Some believe that by performing angiography immediately on arrival of ACS patient is an efficient approach. In patients in whom lesion is not found may be discharged rapidly or shifted to a different management strategy. Patients in whom there is obvious culprit lesions can undergo PCI immediately and thereby reducing hospital stay or can be sent expeditiously to undergo CABG and thereby avoiding risky waiting period.

An early invasive strategy including coronary angiography may be required if aggressive medical therapy fails to stabilize the patient, if prior revascularization procedures have been performed, in the presence of recurrent angina, and in the presence of abnormal non-invasive test results.