Coronary Angiography and PCI Explained
Coronary angiography and percutaneous coronary intervention (PCI) are catheter-based procedures used to examine and, in selected cases, treat narrowed coronary arteries. This page explains what they involve, when they may be considered and what the alternatives are. Many people with coronary artery disease are treated with medication and lifestyle measures alone.
Written by Dr. Jan Niclas Strickling, DHA-licensed: Consultant Cardiology · Consultant Internal Medicine · Specialist Interventional Cardiology. General information only; it does not replace an individual assessment.
Coronary Angiography
Coronary angiography visualises the coronary arteries using contrast dye and X-ray imaging. It is typically considered when symptoms or non-invasive tests suggest a significant narrowing, or during an acute heart attack, to help define whether further treatment may be beneficial. Non-invasive tests such as CT coronary angiography or stress testing are often used first.
PCI and Coronary Stents
PCI widens a narrowed coronary artery from the inside using a balloon, usually followed by placement of a stent. In an acute heart attack, prompt PCI can restore blood flow. In stable coronary disease, large randomised trials (such as ISCHEMIA) found that PCI can relieve angina, but in many patients did not reduce heart attacks or deaths compared with optimal medical therapy. The choice therefore depends on symptoms, anatomy and individual goals.
Pressure Measurements and Intracoronary Imaging
Not every narrowing restricts blood flow. Pressure-wire measurements such as fractional flow reserve (FFR) assess whether a narrowing is functionally significant, and trials have shown that using FFR can avoid unnecessary stents. Intracoronary imaging with IVUS or OCT shows the vessel wall in detail and can help size and expand a stent.
- Coronary angiography
- PCI and coronary stents
- Fractional flow reserve (FFR)
- Intravascular ultrasound (IVUS)
- Optical coherence tomography (OCT)
- Intravascular lithotripsy for calcified arteries
Alternatives, Risks and Individual Decisions
Options for coronary artery disease include lifestyle changes, medication, PCI and coronary bypass surgery. Which option is suitable, and its expected benefits and risks, can only be judged after an individual assessment. For complex disease, current European guidelines recommend discussion within a heart team that includes cardiac surgeons.
Frequently Asked Questions
- Interventional cardiology is a sub-specialty of cardiology that uses catheter-based procedures to diagnose and treat heart and blood vessel conditions. Examples include coronary angiography and percutaneous coronary intervention (PCI), usually performed through a small puncture at the wrist or groin rather than open surgery.
- Coronary angiography may be considered when symptoms, ECG changes or non-invasive tests suggest a significant narrowing of the coronary arteries, or urgently during a heart attack. It is not required for every person with chest pain. Whether it is appropriate is decided individually by the treating doctor.
- A thin catheter is guided to the narrowed segment of a coronary artery. A balloon is inflated to widen the narrowing and a stent (a small mesh tube) is usually placed to help keep the vessel open. Intracoronary imaging and pressure measurements may be used to guide the procedure.
- Most procedures are completed without major problems, but risks exist. These include bleeding or bruising at the access site, allergic reactions or kidney strain from contrast dye, heart rhythm disturbances, damage to the artery and, rarely, heart attack, stroke or need for emergency surgery. The individual risk depends on a person's health and the complexity of the procedure and should be discussed with the treating team.
Related Topics
General information, not personal advice
These pages explain conditions and procedures in general terms. Whether a test, medicine or procedure is appropriate, and its alternatives and risks, can only be decided after an individual assessment by your own treating doctor. If you have chest pain, severe breathlessness or collapse, call emergency services immediately.
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