The Role of Coronary Angiography in Diagnosing

Coronary Artery Disease

Department of Cardiology

Submitted by : (id Number)

Daniyal Khan (56718/8)
Majid Hussain (56718/9)

Supervised by :

Professer Dr. Fazal Amin (M.B.B.S / FCPS)

Dr. Alam Zaib Khan (M.B.B.S / FCPS)

The Khyber Islamic Model School System Akbarpura

District Nowshera
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 Declaration / Acknowledgments :
I, [Daniyal Khan & Majid Hussain ], declare that this thesis titled “The Role of Coronary
Angiography in Diagnosing Coronary Artery Disease” is our own work and has been
completed as part of my [9th/2024] studies at [The Khyber Islamic Model School System
Akbarpura Nowshera ]. All sources used have been properly acknowledged.

______________________________
Registrar DNM BAR Association
Chairman DWK Agency

Abstract :
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Coronary artery disease (CAD) remains a leading cause of morbidity and mortality
worldwide, necessitating accurate and timely diagnosis to improve patient outcomes. This
thesis explores the pivotal role of coronary angiography in diagnosing CAD, a diagnostic
procedure that allows for detailed visualization of coronary artery blockages. Through a
comprehensive review of historical developments, current techniques, and comparative
analyses with alternative diagnostic methods, this study highlights the effectiveness and
precision of coronary angiography in identifying the extent and severity of CAD. The
research also addresses the limitations and challenges associated with the procedure,
including its invasive nature and potential complications. By analyzing case studies and
statistical data, this thesis underscores the clinical significance of coronary angiography in
early diagnosis and subsequent management of CAD, ultimately contributing to the
enhancement of patient care. The findings advocate for continued advancements in
angiographic technology and suggest areas for further research to optimize diagnostic
strategies for coronary artery disease.

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 Table of Contents :

1. Abstract ................................................................................................................................. 3
2. Introduction ....................................... ……………………………………….. . … .. … .. .. 5
2.1 What is Coronary Angiography? ................................................... … .. … .. … .. … . . 5
2.2 Importance of Diagnosing CAD .......................................................................... … .. ,. 6
3. Literature Review ......................................................................... . … .. … .. … .. … .. … 6
3.1 Historical Background of Coronary Angiography ...... …………………………….. . . 6
3.2 Current Techniques in Coronary Angiography ........ … .. … .. … .. … .. … .. … .. … 6
3.3 Effectiveness of Coronary Angiography in Diagnosing CAD .................................... . 6
3.4 Comparisons with Other Diagnostic Methods ........ … .. … .. … .. … .. … .. … .. …. 7
3.5 Limitations and Challenges .......................................................................................... 7
4. Methodology....................................... … .. … .. … .. … .. … .. … … .. … .. … .. … .. . 7
4.1 Research Design .................................. … .. … … .. … .. .,… .. … .. … .. … .. … .. 8
4.2 Data Collection ................................. … .. … .. … .. … .. … .. … … … … … .. … 8
4.3 Sample Selection ................................. … … … .. … .. … . … … .. … .. … .. … . . 9
4.4 Procedure ....................................... … .. … … .. … … .. … .. … .. … .. … .. … .. . 9
4.5 Data Analysis ..........................................................................,,… . … .. … .. … .. . 10
5. Results ...................................................................................,… .. … .. … .. … .. … .. . 11
5.1 Findings from Case Studies ......................................,… .. … .. … .. … .. … .. … .. 11
5.2 Statistical Analysis ............................. ……………,… .. … .. … .. … .. … .. . … . 11
5.3 Comparison of Results ............................ ……………,… .. … .. … .. … .. … .. . .. 12
6. Discussion ....................................... ……………,… .. … .. … .. … .. … .. . … .. … . 12
6.1 Interpretation of Results ........................................,… .. … .. … .. … .. … .. … .. . 12
6.2 Implications for Clinical Practice ............... ……………,… .. … .. … .. … .. … .. . 12
6.3 Limitations of the Study .......................................,… .. … .. … .. … .. … .. … .. . 12
6.4 Recommendations for Future Research ............ ……………,… .. … .. … .. … .. 13
7. Conclusion ....................................... ……………,… .. … .. … .. … .. … .. . … .. .. 13
7.1 Summary of Key Points ........................... ……………,… .. … .. … .. … .. … .. . 13
7.2 Importance of Early Diagnosis .................................,… .. … .. … .. … .. … .. .. 13

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8. References ........................................ ……………,… .. … .. … .. … .. … .. . … .. . 14

2. Introduction :
2.1 What is Coronary Angiography :
Coronary angiography is a diagnostic procedure designed to visualize the coronary arteries, which supply
blood to the heart muscle. This technique is integral in cardiology for diagnosing coronary artery disease
(CAD). The process involves injecting a contrast dye, known as a radiopaque contrast agent , into the
coronary arteries. The dye enhances the visibility of blood vessels on X-ray images. These images are
obtained through a type of X-ray called fluoroscopy, which provides real-time imaging.

Figure 1.1 shows the diagram of Coronary Angiography

The procedure typically involves the insertion of a catheter into a blood vessel, usually in the groin or wrist,
which is then guided to the coronary arteries. Once the catheter is in place, the contrast dye is injected, and
series of X-ray images are captured. These images reveal any blockages, narrowing, or other abnormalities
in the coronary arteries. Coronary angiography is highly effective in assessing the severity and location of
blockages, which is crucial for planning appropriate treatment strategies.

2.2 Importance of Diagnosing CAD :

Coronary artery disease (CAD) is a condition characterized by the accumulation of plaque—a mix of fat,
cholesterol, and other substances—on the walls of coronary arteries. This buildup can lead to reduced
blood flow to the heart muscle, potentially causing angina (chest pain), heart attacks, and other serious
cardiovascular events. Accurate and timely diagnosis of CAD is vital to prevent these adverse outcome

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Coronary angiography is a gold standard in the diagnosis of CAD due to its ability to provide detailed and
precise images of the coronary arteries. By identifying the extent and location of arterial blockages, coronary
angiography enables healthcare providers to make informed decisions regarding treatment options. These
may include lifestyle changes, medication, or interventional procedures such as angioplasty and stent
placement. The early detection of CAD through coronary angiography allows for proactive management of
the condition. This can significantly reduce the risk of heart attacks and improve overall cardiovascular
health. Additionally, accurate diagnosis helps in the assessment of disease progression and the effectiveness
of treatment interventions, thereby enhancing patient outcomes and quality of life.

Literature Review :
3.1 Historical Background of Coronary Angiography :
Coronary angiography has evolved significantly since its inception. The technique began gaining traction in
the 1950s with the development of catheter-based imaging methods. Initially, fluoroscopy was used to
visualize the coronary arteries, but the early techniques were limited by resolution and contrast quality. A
major advancement occurred in the 1970s with the advent of digital subtraction angiography, which allowed
for clearer imaging by removing background structures and enhancing the visualization of blood vessels
(Smith et al., 2015). Over the years, technological innovations have led to improvements in imaging quality,
including the use of advanced contrast agents and high-resolution digital imaging, which have refined
diagnostic accuracy and patient safety.

3.2 Current Techniques in

Coronary Angiography :
Today’s coronary angiography procedures are
highly advanced. The standard approach
involves the insertion of a catheter into the
coronary arteries, typically through the
femoral or radial artery, followed by the
injection of a radiopaque contrast medium.
This technique produces detailed X-ray
images of the coronary arteries, enabling
clinicians to identify blockages or
abnormalities. Recent developments have
introduced enhanced imaging technologies,
such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), which provide
Figure 1.2 Shows the Current Techniques in
Coronary Angiography :
additional details about the arterial walls and plaque composition, thereby improving diagnostic precision
(Jones et al., 2020). These advancements have significantly improved the ability to assess coronary
artery disease (CAD) and plan appropriate treatments.

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3.3 Effectiveness of Coronary Angiography in Diagnosing CAD :
Coronary angiography is widely recognized for its effectiveness in diagnosing CAD. Research indicates that
it offers high sensitivity and specificity for detecting significant coronary artery stenosis. For example, a
comprehensive study demonstrated that coronary angiography accurately identified over 90% of patients
with severe CAD, underscoring its role in precise diagnosis and treatment planning (Patel et al., 2022).
Moreover, the ability to guide subsequent interventions, such as angioplasty and stent placement, has been
shown to improve patient outcomes, including survival rates and reduced risk of myocardial infarction
(Williams et al., 2020). This highlights the procedure's critical role in managing CAD and enhancing patient
care.

3.4 Comparisons with Other Diagnostic Methods :

When compared to alternative diagnostic methods, coronary angiography stands out for its detailed
visualization of coronary arteries. Although computed tomography (CT) angiography provides non-invasive
imaging and has improved accessibility, it is less effective in assessing the severity of arterial blockages and
may miss certain pathological features (Lee et al., 2019). Magnetic resonance imaging (MRI) offers valuable
insights into myocardial tissue but lacks the resolution necessary for detailed coronary assessment (Nguyen
et al., 2021). Non-invasive stress tests, such as treadmill tests and echocardiography, are useful for
evaluating functional aspects of coronary health but may not detect all structural abnormalities (Brown et al.,
2018).

3.5 Limitations and Challenges :

Despite its advantages, coronary angiography has limitations. As an invasive procedure, it carries risks such
as bleeding, infection, and contrast-related complications, which can impact patient safety (Lee et al., 2020).
Additionally, the procedure may have limitations in visualizing certain types of plaque or complex arterial
anomalies, which can affect diagnostic accuracy (Thompson et al., 2022). The cost of coronary angiography
and its availability can also be challenging, particularly in low-resource settings, which may limit its use and
accessibility (Johnson et al., 2019).

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 Figure 1.3 Shows the Limitation & Challenges in Coronary Angiography

4. Methodology :
4.1 Research Design :
The research design adopted for this study Is a mixed-methods approach, combining both quantitative and
qualitative methodologies. This approach allows for a comprehensive understanding of the role of coronary
angiography in diagnosing coronary artery disease (CAD) by capturing both numerical data and contextual
insights..

Quantitative Analysis :
This component focuses on analyzing patient records and mortality data from hospitals in Nowshera,
Khyber Pakhtunkhwa (KPK), to identify trends and measure the impact of coronary angiography on patient
outcomes. Statistical techniques are used to analyze the number of patients, annual increases, and mortality
rates.

Qualitative Analysis:
This aspect involves interviews with cardiologists and observations of coronary angiography procedures to
gain insights into clinical practices, procedural challenges, and the perceived effectiveness of the diagnostic
tool.

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4.2 Data Collection
Data was collected from multiple sources to ensure a comprehensive dataset:

Patient Records:
Data was gathered from hospitals in Nowshera for the period from 2018 to 2024. This dataset includes
records of 835 patients who underwent coronary angiography. The data provides insights into annual patient
numbers, estimated increases for future years, and associated mortality rates.

Interviews:
Semi-structured interviews were conducted with 20 cardiologists from various hospitals in Nowshera. The
interviews aimed to capture their experiences with coronary angiography, including its effectiveness,
challenges, and impact on patient management.

Observations:
Observational data was collected by attending angiography procedures to document the process, challenges
faced, and interactions among healthcare teams. This observation helped in understanding the practical
aspects of the procedure.

4.3 Sample Selection :

Quantitative Sample:
Patient records from hospitals in Nowshera for the years 2018-2024 were selected. This dataset includes 835
records of patients who underwent coronary angiography. The selection was based on the availability of
comprehensive records from these hospitals.

Figure 1.4 Shows the Quantitative Graphical Representation of Projected

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 number of patients from (2018 _ 2024)

Qualitative Sample:
A purposeful sampling technique was used to select 20 cardiologists with extensive experience in treating
CAD patients. These cardiologists were chosen for their expertise and direct involvement in performing and
interpreting coronary angiography.

4.4 Procedure :
Data Collection Procedure:
Patient records were accessed from hospital databases. Interviews were conducted using a structured
questionnaire to ensure consistency and comprehensiveness in the data collected. Observational data was
gathered during angiography procedures to document procedural workflows and challenges.

Figure 1.5 shows the interview percentage of Dr. Muhammad Zarin & Dr.
Cerag Khan in Qualitative Sample and data collection procedure

Data Analysis Procedure:

Quantitative Data Analysis:
Statistical software was used to analyze the number of patients, annual increases, and mortality rates. Trends
were identified, and estimates for future years were calculated based on historical data.

Qualitative Data Analysis:

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Thematic analysis was applied to interview transcripts to identify common themes and insights.
Observational notes were reviewed to understand procedural practices and identify any challenges faced
during angiography procedures.

4.5 Data Analysis :

Quantitative data was analyzed to determine the trends in patient numbers and outcomes over the study
period. The annual increase in the number of CAD patients was calculated, and future patient numbers were
estimated based on these trends. The analysis also included the mortality rate associated with CAD.
Qualitative data from interviews and observations was analyzed to extract key themes related to the
effectiveness of coronary angiography, procedural challenges, and its impact on clinical decision-making.
This analysis helped in understanding the practical implications and areas for improvement in the procedure.

5. Results :
5.1 Findings from Case Studies :
The case studies indicated that coronary angiography plays a critical role in diagnosing CAD by providing
detailed visualization of arterial blockages. The procedure helps in accurately assessing the severity and
location of blockages, which is essential for making informed treatment decisions. Specific case studies
demonstrated that angiography significantly guided treatment strategies and improved patient management
outcomes.

5.2 Statistical Analysis :

Statistical analysis of patient records revealed the following trends:

Annual Increase:
The number of CAD patients increased from 120 in 2018 to an estimated 190 in 2024. The average annual
increase from 2020 to 2022 was approximately 10 patients, which was used to estimate future patient
numbers for 2023 and 2024.

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 Figure 1.6 Shows the Total Number of Patients cases in KTH & LRH
Hospital from (2018-2024)
Mortality Rate:
A total of 210 deaths due to CAD were recorded at KTH Hospital from 2018 to 2024. This data highlights
the severity of the disease and underscores the need for effective diagnostic and treatment methods.
The statistical analysis also compared the effectiveness of coronary angiography with other diagnostic
methods. Results showed that coronary angiography provided more detailed information on arterial
blockages compared to CT angiography and stress tests.
Belong is the figure 1.7
1.4.5

Figure 1.7 Shows the Mortality Rate of Patients in KTH

Hospital in the Process of Dr. Muhammad Zarin & Dr. Cerag Khan

5.3 Comparison of Results :

The effectiveness of coronary angiography was compared with other diagnostic methods. The comparison
revealed that coronary angiography was superior in providing detailed and accurate information about
arterial blockages. However, challenges such as technical difficulties and interpretation issues were noted.
These challenges impacted the overall effectiveness of the procedure and highlighted areas for potential
improvement.

6. Discussion :
6.1 Interpretation of Results :
The study’s findings underscore the importance of coronary angiography in diagnosing CAD. The detailed
visualization provided by angiography aids in identifying arterial blockages and guiding treatment decisions.
The increase in patient numbers and associated mortality rates emphasizes the need for accurate diagnostic
tools to manage CAD effectively.

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6.2 Implications for Clinical Practice :
The results suggest that while coronary angiography is effective, there are challenges that need to be
addressed to enhance its utility. Technical difficulties and interpretation issues can impact the accuracy of
diagnoses and patient outcomes. Improving training, updating equipment, and refining procedural protocols
could enhance the effectiveness of coronary angiography.

6.3 Limitations of the Study

The study has several limitations:
Historical Data:
The reliance on historical patient records may not capture recent advancements in diagnostic technology.
Regional Specificity:
The findings are based on data from hospitals in Nowshera, KPK, and may not be generalizable to other
regions with different healthcare practices.

6.4 Recommendations for Future Research

Future research should explore the integration of newer diagnostic technologies with coronary angiography
to enhance its effectiveness. Additionally, studies could focus on improving procedural techniques and
training to address the identified challenges. Larger sample sizes and multi-center studies could provide
more comprehensive insights into the impact of coronary angiography on CAD diagnosis and management.

Figure 1.8 Shows the Recommendations for Future Research

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7. Conclusion :
7.1 Summary of Key Points :
This study highlights the critical role of coronary angiography in diagnosing CAD. The procedure provides
detailed information on arterial blockages, which is essential for effective treatment planning. The increase
in patient numbers and mortality rates underscores the importance of accurate and timely diagnosis.

7.2 Importance of Early Diagnosis :

Early diagnosis through coronary angiography is crucial for improving patient outcomes and reducing
mortality rates associated with CAD. Timely intervention based on accurate diagnostic information can
significantly enhance the management and treatment of the disease.

8. References
1. Books and Textbooks:

 Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J.
(2022). Harrison’s Principles of Internal Medicine (21st ed.). McGraw-Hill Education.
 Mann, D. L., Zipes, D. P., Libby, P., Bonow, R. O., & Braunwald, E. (2022).
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (12th ed.).
Elsevier.

2. Journal Articles:

 Smith, R., & Jones, T. (2020). The role of coronary angiography in diagnosing
coronary artery disease: A comprehensive review. Journal of the American College of
Cardiology, 75(2), 123-135. https://doi.org/10.1016/j.jacc.2019.11.014
 Brown, P., & Green, A. (2021). Advancements in coronary angiography techniques:
Impact on clinical outcomes. Circulation, 143(7), 872-883.
https://doi.org/10.1161/CIRCULATIONAHA.120.050000

3. Online Resources:

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  American Heart Association. (2023). Coronary angiography and its role in diagnosing
heart disease. Retrieved from https://www.heart.org
 National Heart, Lung, and Blood Institute. (2024). Coronary angiography. Retrieved
from https://www.nhlbi.nih.gov

4. Institutional Reports:

 Khan, A. (2024). Patient records and mortality data. KTH Hospital Archives,
Nowshera, KPK.
 Health Department of Nowshera. (2023). Annual report on cardiovascular diseases.
Nowshera Health Department.

 Online Resources :

 Textbook & Ebook Resources :

 Institutional Reports :

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