Coronary angiography
How to read an angiogram report (dominance, stenosis grading, TIMI flow, FFR and iFR, SYNTAX), who needs one under current Australian and ESC guidance, and the complications to warn about.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Invasive coronary angiography shows the lumen, not the wall. It grades stenosis by eye and tells you nothing about whether a lesion causes ischaemia.
- Add pressure-wire physiology (FFR or iFR) for intermediate lesions and intravascular imaging (IVUS or OCT) for left main and complex PCI.
- It's the reference test for anatomy, and the only one that allows treatment in the same sitting (PCI).
Loading the rest of the note…
Finished reading?
Sources
- Brieger D, Cullen L, Briffa T et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Comprehensive Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025. Heart Lung Circ 2025;34(4):309-397AU/NZNational Heart Foundation of Australia and CSANZ (Heart, Lung and Circulation), 2025
- Medicare Benefits Schedule item 38244 and explanatory note TR.8.2 (selective coronary angiography: eligible indications)AU/NZAustralian Government Department of Health, Disability and Ageing (MBS Online), accessed November 2026
- Iodinated contrast media guideline (contrast reactions, contrast-associated AKI and metformin)AU/NZRoyal Australian and New Zealand College of Radiologists, 2018
- Davenport MS, Perazella MA, Yee J et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020;2(1):85-93 (applies to IV, not intra-arterial, contrast)American College of Radiology and National Kidney Foundation, 2020
- Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-537European Society of Cardiology, 2024
- Rao SV, O'Donoghue ML, Ruel M et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation 2025;151:e771-e862American College of Cardiology and American Heart Association, 2025
- Lemkes JS, Janssens GN, van der Hoeven NW et al. Coronary angiography after cardiac arrest without ST-segment elevation (COACT). N Engl J Med 2019;380:1397-407New England Journal of Medicine, 2019
- Valgimigli M, Gagnon A, Calabrò P et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management (MATRIX). Lancet 2015;385:2465-76The Lancet, 2015
- Jolly SS, Yusuf S, Cairns J et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL). Lancet 2011;377:1409-20The Lancet, 2011
- Escaned J, Travieso A, Dehbi HM et al. Coronary revascularization guided with fractional flow reserve or instantaneous wave-free ratio: a 5-year follow-up of the DEFINE FLAIR randomized clinical trial. JAMA Cardiol 2025;10(1):25-31JAMA Cardiology, 2025
- Eftekhari A, Holck EN, Westra J et al. Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR. Eur Heart J 2023;44(41):4376-84European Heart Journal, 2023
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback