Indications for coronary arteriography: risks vs. benefits.

Coronary arteriography has become a diagnostic procedure which is no longer limited to major medical centers but is being performed in many community hospitals. The procedure carries an appreciable risk, which is only justifiable by specific benefits to the patient. The benefits are related to the potential availability of newer surgical procedures of bypassing obstructive coronary arterial lesions. A specific set of criteria for the performance of coronary arteriography has been developed from a critical analysis of the ratio of risk to benefit. A survey of the risk of coronary arteriography indicates that mortality increases at least twentyfold and morbidity sixfold when this procedure is performed in laboratories with a low caseload as compared with high caseload institutions. Thus there appears to be no justification for performing coronary arteriography in the absence of proper team facilities.