From the Guidelines
Angioplasty is the preferred procedure over angiogram alone for patients with suitable coronary anatomy, as it reduces hospital stay by 30%, costs by 15%, and radiation exposure, while enhancing the safety of the procedure 1. When considering angioplasty vs angiogram, it's essential to understand the purpose and benefits of each procedure. An angiogram is a diagnostic test used to visualize blood vessels and detect blockages, while angioplasty is a therapeutic procedure that treats blocked or narrowed arteries.
Key Considerations
- A staged approach to coronary angioplasty after cardiac catheterization has advantages, including more time to plan the dilation strategy and discuss therapeutic options with the patient and family 1.
- Combined angiography and angioplasty is suitable for patients with signs or symptoms suggesting restenosis, those who cannot be stabilized and require urgent PTCA, and patients undergoing PTCA for an acute myocardial infarction 1.
- Pretreatment with aspirin is crucial, and patients should be well-informed and prepared before the procedure 1.
Procedure Outcomes
- Most patients can be safely discharged from the hospital within 24 to 48 hours after an uncomplicated angioplasty 1.
- Patients who experience symptoms of myocardial ischemia after the procedure are at risk of abrupt vessel closure, which has a high mortality rate 1.
- Follow-up studies, such as treadmill tests, exercise or pharmacologic stress echocardiography, and stress perfusion scintigraphy, can detect restenosis and recurrent cardiac ischemia 1.
Patient Management
- Patient modification before discharge should include management of hypertension, aggressive control of serum lipids, exercise, and timing of return to full activities 1.
- Patients should be informed of the importance of contacting their physician if they experience any symptoms or concerns after the procedure 1.
From the Research
Angioplasty vs Angiogram: Key Differences
- Angioplasty is a medical procedure used to widen narrowed or blocked arteries, typically performed to treat coronary artery disease or peripheral artery disease 2, 3.
- An angiogram, on the other hand, is a diagnostic test used to visualize the inside of blood vessels and diagnose blockages or other vascular problems 4, 5.
Treatment Outcomes
- Studies have shown that dual antiplatelet therapy with aspirin and clopidogrel may reduce the risk of recurrent thrombosis-related events in patients with acute coronary syndromes or stent revascularization 2, 6.
- However, the efficacy and safety of adding clopidogrel to aspirin for the prevention of graft failure and cardiovascular events after coronary artery bypass grafting (CABG) are still unknown 5.
- Some studies suggest that the addition of clopidogrel to aspirin may be superior for prevention of graft failure in radial artery grafts 5, and may also correlate with less worsening of native coronary artery disease 1 year after CABG 6.
Procedure-Related Risks
- The use of clopidogrel before CABG may increase the risk of perioperative bleeding complications, and should be held for at least 5 days before surgery 3.
- Aspirin should be held for 7-10 days preoperatively in patients undergoing elective CABG, but this practice has been put into question in the current era of routine antifibrinolytic therapy and high prevalence of patients with extensive atherosclerotic disease 3.
Postoperative Care
- Extensive evidence supports the use of aspirin, in doses of 100-325 mg daily, to be administered 48 hours postoperatively and continued indefinitely after CABG 3, 4.
- The role of postoperative clopidogrel therapy is still being studied, but it may be recommended in patients with recent acute coronary syndromes 3, 4.