Coronary angiography

Invasive coronary angiography is used in symptomatic athletes with clinical suspicion of coronary artery disease which presumably requires interventional therapy, i.e. mainly in acute coronary syndrome and myocardial infarction. Because of its invasive nature, it is not used in asymptomatic athletes. Advanced intra-coronary artery imaging, including intra-vascular ultrasound (IVUS), intra-coronary Doppler ultrasound (ICDUS) and assessment of fractional flow reserve (FFR), can help to improve understanding of epicardial and intra-myocardial microvascular causes of symptoms. Plaque rupture, plaque erosion, coronary vasospasm, and thrombotic coronary occlusion have been demonstrated subsequent to athletic activities, but it is uncertain to what extent exhaustive exercise triggered the symptoms that led to invasive angiography. Because of radiation exposure, use of contrast agent, and the costs of the test careful risk–benefit assessment is necessary, especially in asymptomatic athletes with risk factors and in young athletes.