Coronary Angiography

Coronary angiography is the gold standard for invasive ischemic evaluation. This chapter reviews the indications for coronary angiography, as well as the factors that must be considered when deciding between percutaneous and surgical revascularization. It also highlights considerations at the time of arterial access, and potential options for intervention. It focuses not only on percutaneous coronary intervention (PCI) but also reviews key tools for invasive anatomic and physiologic assessment, including fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), diastolic hyperemia-free ratio (DFR), and intravascular ultrasound (IVUS). This chapter also describes indications and considerations for right heart catheterization (RHC), as well as the role RHC can play in guiding clinical care.