Perspective:

The following are 10 points to remember about the appropriate use criteria for diagnostic catheterization:

1. An appropriate diagnostic cardiac catheterization (left heart, right heart, ventriculography, and/or coronary angiography) is one in which the expected incremental information combined with clinical judgment exceeds the negative consequences by a sufficiently wide margin for a specific indication that the procedure is generally considered acceptable care and a reasonable approach for the indication.

2. The category of ‘uncertain’ was used when insufficient clinical data were available for a definitive categorization or there was substantial disagreement regarding the appropriateness of that indication. Those scenarios designated as uncertain reflect variations in clinical practice patterns.

3. Suspected acute coronary syndrome with newly diagnosed left ventricular wall motion abnormality or newly diagnosed resting myocardial perfusion defect is an appropriate indication for diagnostic catheterization.

4. Coronary angiography was rated as appropriate for patients resuscitated after cardiac arrest (assuming return of reasonable neurologic function), and for those with sustained ventricular tachycardia regardless of symptoms.

5. It should be noted that, in general, for patients with planned valvular surgery, preoperative catheterization for coronary anatomy was rated as appropriate.

6. The role of diagnostic catheterization prior to solid organ transplantation is uncertain.

7. Fractional flow reserve or intravascular ultrasound (IVUS) is appropriate in angiographically indeterminate severity left main stenosis (defined as two or more orthogonal views contradictory whether stenosis is >50%).

8. Angiography is inappropriate in asymptomatic patients with low-risk findings (e.g., <5% ischemic myocardium on stress single-photon emission computed tomography myocardial perfusion imaging or stress positron emission tomography, no stress-induced wall motion abnormalities on stress echo or stress cardiac magnetic resonance).

9. Coronary calcium scores, regardless of severity, were rated as inappropriate indications for invasive coronary angiography in asymptomatic patients.

10. Specific groups such as those suspected of pericardial disease, intracardiac shunts, tamponade, suspected cardiomyopathy, or patients who have received cardiac transplant were rated as appropriate for hemodynamic studies and endomyocardial biopsy.