From the Guidelines
Cardiac catheterization is indicated for diagnostic and therapeutic procedures in patients with complex congenital heart disease, particularly when noninvasive imaging is inadequate or inconclusive, as stated in the 2011 American Heart Association scientific statement 1. The primary indications for cardiac catheterization include:
- Evaluation of anatomy and hemodynamics in complex congenital heart disease
- Assessment of high-flow or low-flow physiology associated with semilunar valve stenosis
- Determination of true peak-to-peak gradient measurements in combined aortic stenosis and insufficiency, or pulmonary stenosis and insufficiency
- Calculation of pulmonary arteriolar resistance in low-flow lesions
- Evaluation of patients with conflicting noninvasive data The catheterization laboratory is essential for providing definitive anatomical and physiological information about the cardiovascular system, and for offering immediate therapeutic options when indicated, such as interventional catheterization procedures 1. In cases where noninvasive imaging is not sufficient, cardiac catheterization is necessary to confirm congenital or acquired heart disease in infants and children, and to assess patient hemodynamics and anatomy by angiography 1. It is crucial to note that diagnostic catheterization should not be considered routine for diagnosis of congenital defects, and the performance of complete right- and left-sided heart studies may subject patients to unnecessary risk and exposure to radiation 1. Therefore, the decision to perform cardiac catheterization should be based on individual patient needs and the availability of adequate noninvasive imaging, with the capability to proceed with interventional procedures if necessary 1.
From the Research
Indications for Cardiac Catheterization Laboratory
The indications for a cardiac catheterization (cath) laboratory include:
- Diagnosis of coronary artery disease (CAD) using invasive coronary angiography 2, 3
- Performance of interventional procedures such as primary percutaneous coronary intervention (PPCI) for acute ST-elevation myocardial infarction (STEMI) 4
- Assessment of the hemodynamic relevance of a given coronary stenosis using fractional flow reserve and instantaneous wave-free ratio 3
- Evaluation of patients with high pre-test probability of CAD, with coronary computed tomography angiography (CCTA) as a potential first-choice imaging diagnostic 5, 6
- Exclusion of significant CAD in patients referred to the Cath-Lab 5
- Follow-up after coronary revascularization 5
- Cardiovascular risk stratification 5
Specific Patient Populations
Certain patient populations may benefit from cardiac catheterization laboratory procedures, including:
- Patients with acute ST-elevation on an electrocardiogram (ECG) in the proper clinical context 4
- Patients with high pre-test probability of CAD 6
- Patients with suspected coronary ischemia, who may undergo stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging 2