Is coronary angiography painful?

PCI Training Simulator

Some people have read popular science, and the doctor said that less than 70% of the coronary artery stenosis does not require a stent. But some people have less than 70% coronary artery stenosis in CT angiography, but doctors let them do coronary angiography with a catheter. Therefore, some patients feel puzzled and even question the doctor's overtreatment.

First, such coronary stenosis of less than 70% does not require a stent, excluding left main coronary artery disease.

Left main disease is a very serious disease. Because in case of blockage, the two main coronary arteries are gone. Therefore, if there is more than 50% stenosis of the left main artery, it should be treated.

Under normal circumstances, the coronary arteries have a reserve function, which is 4 to 5 times the usual blood flow. After atherosclerosis, the reserve function decreases, but the stenosis below 70% can still maintain myocardial blood supply under normal daily physical load.

After stent implantation, intensive antiplatelet drug therapy is required, which will increase the risk of bleeding; if the drug is insufficient, it will increase the risk of coronary thrombosis; there is also the possibility of restenosis after stenting. Importantly, clinical studies have confirmed that stent placement does not improve the prognosis of patients with stable coronary artery disease.

Therefore, the relevant guidelines for coronary intervention in my country recommend direct interventional treatment when the coronary artery stenosis is ≥90%; when the stenosis of the coronary artery is greater than 70% but less than 90%, there is corresponding evidence of ischemia or fractional flow reserve (FFR) ≤0.8 , interventional treatment will be carried out.

Therefore, in general, patients with coronary artery stenosis below 70% do not need coronary angiography.

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