Coronary angiogram (cardiac catheterisation)
A test where a fine tube is passed through an artery in the wrist or groin to the heart and dye is injected, so X-rays can show whether the coronary arteries are narrowed or blocked.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A fine tube is passed through an artery in the wrist or groin to the heart, and dye plus X-rays show whether the coronary arteries are narrowed or blocked.
- It is the most detailed test of the coronary arteries and is often used when other tests are unclear or treatment is likely.
- Because a tube is placed inside an artery, it carries a small but real risk of serious complications, unlike non-invasive scans.
- A narrowing can sometimes be treated with a stent in the same sitting, but that is a separate decision you should be part of.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives the most detailed view of the coronary arteries and any narrowings or blockages.
When a non-invasive test such as a CT coronary angiogram would safely answer the question, the invasive risk may not be justified.
You rest and are monitored while the artery seals. With a wrist approach you can often sit up soon; with a groin approach you usually lie flat for a few...
Clear, written instructions on access-site care and what to do if it bleeds.
You rest and are monitored while the artery seals. With a wrist approach you can often sit up soon; with a groin...
Most people go home the same day once the site is stable. You should not drive yourself, and someone should stay...
Keep the site clean and dry, avoid heavy lifting and straining, and follow advice on the wrist band or groin...
Gradually return to normal activity, avoiding heavy lifting and strenuous exercise, particularly after a groin...
What is a coronary angiogram (cardiac catheterisation)?
A coronary angiogram, also called cardiac catheterisation, is a test that shows the inside of the arteries supplying your heart muscle, the coronary arteries. A fine, flexible tube called a catheter is passed into an artery, usually at the wrist or sometimes the groin, and guided up to the heart. A dye that shows up on X-rays is injected through the catheter, and X-ray pictures show how blood flows through the arteries and whether any are narrowed or blocked.
It is used to find out whether coronary artery disease is causing symptoms such as chest pain, to assess how severe any narrowings are, and to plan treatment. It is the most detailed test of the coronary arteries and is often used when other tests have been unclear or when treatment is likely to be needed.
Unlike most heart scans, this is an invasive test, meaning a tube is placed inside an artery. Because of that, it carries a small but real risk of complications. Often, if a significant narrowing is found, it can be treated in the same sitting with a balloon and stent (angioplasty), but this is a separate decision that should be discussed with you. As a test, it shows the arteries; it does not by itself measure how well the heart muscle is working, which may need other tests.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Invasive angiogram versus CT coronary angiogram
| Feature | Invasive angiogram | CT coronary angiogram |
|---|---|---|
| How it is done | Catheter into an artery | An outside CT scan |
| Invasive | Yes | No |
| Can treat at the same time | Yes (stent) | No |
| Usual role | When treatment is likely | Often the first-line test |
A CT angiogram is often used first to look for disease, with an invasive angiogram when treatment is likely or detail is needed.
Preparing for your procedure
- You will usually have blood tests and a heart tracing (ECG) beforehand, and the procedure explained so you can give informed consent.
- Tell the team about diabetes, kidney problems and any allergy, especially to the X-ray dye, as these need planning for.
- Ask which medicines to take or hold; blood thinners and some diabetes medicines such as metformin may need adjusting.
- You may be asked not to eat for a few hours beforehand, though you can often take sips of water and essential tablets.
- Arrange for someone to take you home and stay with you, as you should not drive immediately afterwards.
- Plan a few days off heavy lifting and strenuous activity, especially if the groin route is used.
- Bring a list of your medicines and wear comfortable clothing.
- Ask whether treatment, such as a stent, might be done in the same sitting and discuss this in advance.
What happens
You lie on an X-ray table and the wrist or groin is cleaned and numbed with local anaesthetic. You stay awake, though a mild sedative can be given to help you relax. A fine tube is inserted into the artery and gently guided up to the heart; you should not feel it moving inside you.
Dye is injected through the catheter and you may feel a brief warm flush. X-ray pictures are taken from several angles as the dye flows through the coronary arteries, showing any narrowings or blockages. The cardiologist can often see the results on screen during the test. If a significant narrowing is found and has been agreed with you, it may be treated with a balloon and stent there and then.
A diagnostic test often takes around 30 minutes to an hour. Afterwards the tube is removed and pressure is applied, or a small plug or band is used, to seal the artery and stop bleeding. You then rest and recover before going home, usually the same day.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When a non-invasive test such as a CT coronary angiogram would safely answer the question, the invasive risk may not be justified.
- Severe kidney impairment, where the dye load needs careful planning or an alternative considered.
- A known severe reaction to the X-ray dye that cannot be safely managed.
- When the patient is too unwell for the procedure to be done safely, unless it is an emergency.
- When the result would not change management.
Delay or rearrange if…
- Active infection, including at the planned access site.
- Uncontrolled bleeding risk or blood thinners that have not been reviewed.
- Poor kidney function that needs optimising before the dye is given.
- An acute illness that is not an emergency and could be stabilised first.
- Missing key results, such as blood tests, needed before the procedure.
Alternatives to discuss
- A CT coronary angiogram to look at the arteries without entering them, often used first.
- A myocardial perfusion scan or stress echocardiogram to assess blood flow to the muscle.
- A stress perfusion cardiac MRI, which avoids X-ray radiation.
- Medicines and risk-factor management without invasive testing in lower-risk situations.
- No test, with watchful waiting, if the risk is judged low and symptoms are stable.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Gives the most detailed view of the coronary arteries and any narrowings or blockages.
- Helps confirm or rule out significant coronary artery disease as a cause of symptoms.
- Allows the severity and position of narrowings to be assessed accurately.
- Can guide and inform decisions about medicines, stents or bypass surgery.
- Often allows treatment with a stent in the same sitting if a significant narrowing is found.
- Can clarify the situation when other tests have been unclear.
Risks & complications
- Bruising, soreness or a small lump where the catheter went in.
- A brief warm or flushing feeling when the dye is injected.
- Mild discomfort in the wrist or groin afterwards.
- A larger bruise or a collection of blood (haematoma) at the entry site.
- An allergic-type reaction to the X-ray dye, such as a rash or itching.
- Temporary effect on kidney function from the dye, especially if kidneys are already impaired.
- Damage to the artery where the catheter was inserted, reported in around 1 in 500 procedures.
- A heart attack or stroke triggered by the procedure.
- A serious allergic reaction to the dye.
- Serious bleeding or artery damage needing treatment.
- Death, which is very rare, reported at around 1 in 10,000 procedures.
Because this is an invasive test, it carries a small but real risk of serious complications such as heart attack, stroke and, very rarely, death; NHS information puts the risk of death at around 1 in 10,000 and damage to the access artery at around 1 in 500. The risk is higher in people who are more unwell or who have other health problems. The dye also needs care if your kidneys are not working well. Ask your cardiologist about your personal risk, why an invasive test is preferred over a scan, and whether treatment might be done at the same time.
Published figures to discuss
Because this is invasive, the procedure carries a small but real risk of serious complications, and reasonable figures exist from NHS sources and large series. The risk is higher in people who are more unwell or have other health problems, so individual risk varies. The dye also affects the kidneys in some people. These figures are best understood as cautious averages, not guarantees for any one person.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Damage to the access artery (wrist or groin) | Uncommon; reported at around 1 in 500 procedures in NHS information | Includes bleeding, a collection of blood or artery injury at the entry site, sometimes needing treatment. | NHS — Cardiac catheterisation and coronary angiographynhs.ukPublished figure |
| Death related to the procedure | Very rare; reported at around 1 in 10,000 procedures in NHS information | Risk is higher in people who are more unwell or have significant other conditions. | NHS — Cardiac catheterisation and coronary angiographynhs.ukPublished figure |
| Heart attack or stroke | Rare; serious events such as heart attack or stroke are reported in well under 1% of diagnostic procedures | Exact figures vary with how unwell the person is and whether treatment is carried out at the same time. | NHS — Coronary angiography: risksnhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery is usually quick, especially with the wrist approach, but because an artery has been entered there are real restrictions for a few days on lifting, exertion and driving. You also need to know the signs of bleeding or a problem at the access site.
- Bruising, tenderness or a small lump at the wrist or groin that settles over days to weeks.
- Mild aching in the arm or leg used for access.
- Feeling a little tired for a day or so.
- A small amount of discomfort when moving the wrist or hip at first.
- Knowing the main result on the day, with a fuller plan soon afterwards.
Aftercare
- Keep the access site clean and dry and follow the advice you are given about dressings or the wrist band.
- Avoid heavy lifting, straining and strenuous exercise for the advised period, especially after a groin approach.
- Drink fluids normally to help clear the dye, unless told otherwise.
- Restart medicines, including any blood thinners or diabetes medicines, exactly as advised.
- Do not drive until you are told it is safe; arrange lifts for the first days.
- Watch the access site for bleeding, swelling or a spreading bruise.
- Take any new medicines, such as those after a stent, exactly as prescribed and do not stop them without advice.
- Keep follow-up appointments and know who to contact with concerns.
- Blood tests and ECG done beforehand
- Advice on which medicines to take or hold, including blood thinners
- Allergy to dye and any kidney problems flagged
- Someone to drive you home and stay overnight
- A few days planned off heavy lifting and strenuous activity
- Discussion in advance about possible same-sitting treatment
- Clinic and out-of-hours contact numbers saved
⚠ Get urgent help if…
- Bleeding from the access site that does not stop with firm pressure; apply pressure and call for help.
- A rapidly swelling, very painful or expanding lump at the wrist or groin.
- The hand or foot beyond the access site becoming cold, pale, numb or very painful.
- Chest pain, severe breathlessness or palpitations after going home.
- Sudden weakness, facial droop or slurred speech; call 999.
- Fever, spreading redness or discharge at the access site.
- Producing much less urine than usual, or feeling very unwell, in the days after the dye.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
The cardiologist can often see the coronary arteries on screen during the test, so the main findings are frequently known on the day. A normal angiogram shows arteries without significant narrowing, which is reassuring about coronary disease as a cause of symptoms, though other heart problems may still need looking into. An abnormal angiogram shows where and how severely the arteries are narrowed, which guides whether treatment is with medicines, a stent or bypass surgery.
The test shows the arteries in detail but does not by itself tell you how well the heart muscle is pumping, which may need other tests. Where a narrowing is borderline, extra measurements such as a pressure wire may be used to judge whether it is significant.
An angiogram reflects the state of your arteries at the time of the test. Coronary disease can progress, and new narrowings can develop, so the result does not stay valid indefinitely. If you have a stent, the long-term outcome depends on taking prescribed medicines and managing risk factors. Your cardiologist will advise on follow-up and whether any repeat assessment is needed over time.
Related tests, treatments or support
An invasive angiogram is often part of a wider assessment that includes an ECG, echocardiogram, blood tests and sometimes a CT coronary angiogram or a perfusion scan beforehand. If treatment is needed, it may be combined with angioplasty and stenting in the same sitting, or lead on to a discussion about bypass surgery.
Follow-up & long-term care
The main findings are usually explained on the day, with a fuller plan and any letters following soon afterwards. If you had a stent, you will be given clear instructions about new medicines and follow-up. Make sure you know who to contact about the access site, your medicines or any symptoms, and when you will next be seen.
- Take any medicines started after a stent, such as blood thinners, exactly as prescribed and do not stop without advice.
- Manage risk factors such as blood pressure, cholesterol, smoking and diabetes to slow further disease.
- Attend cardiac rehabilitation or follow-up if offered.
- Have kidney function checked before any future dye-based test if advised.
- Seek prompt review if chest symptoms return or change.
Repeat, follow-on and what comes next
- A borderline narrowing may need extra measurements, such as a pressure wire, to decide if it matters.
- Further procedures may be needed if disease progresses or a stent develops a problem over time.
- A normal angiogram may still prompt other tests if symptoms continue, as the arteries are only part of the picture.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear, written instructions on access-site care and what to do if it bleeds.
- A named contact route and out-of-hours number for problems after going home.
- Clear guidance on medicines, including any started after a stent, and when to restart blood thinners.
- A plan for follow-up, results and any further treatment.
- Advice on managing risk factors and, where relevant, cardiac rehabilitation.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The cardiologist's fee and the catheter laboratory or facility used.
- Whether any sedation is given.
- The contrast dye and any extra measurements, such as a pressure wire or ultrasound inside the artery.
- Whether treatment, such as angioplasty and a stent, is done in the same sitting, which adds device and procedure costs.
- The length of stay and monitoring afterwards.
- Follow-up consultations and any new medicines.
- Aftercare and what happens if a complication occurs.
- The fee for the cardiologist and the catheter laboratory or facility.
- Sedation and contrast dye costs.
- The cost of any stent or extra measurements if treatment is done at the same time.
- Monitoring and any overnight stay if needed.
- Follow-up consultations and any new medicines.
- Cancellation policy and what happens if a complication occurs.
- What is included if the angiogram is normal and no treatment is needed.
On the NHS? Coronary angiography is widely available on the NHS when investigating or treating coronary artery disease; private procedures are sometimes chosen for speed or convenience.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told this is invasive and carries a small but real risk of serious harm.
- No discussion of less invasive alternatives such as a CT coronary angiogram.
- Not agreeing in advance whether treatment, such as a stent, will be done in the same sitting.
- Unclear advice on managing blood thinners and diabetes medicines around the procedure.
- No written aftercare plan or clear instructions about access-site bleeding.
Marketing red flags
- Presenting an invasive angiogram as a routine check for people with no symptoms.
- Recommending it before trying a suitable non-invasive test.
- Downplaying the risks of an invasive procedure or the dye.
- Pressure to agree to a stent without a clear, shared discussion of whether it is needed.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why do I need an invasive angiogram rather than a CT scan or another test?
- What is my personal risk from this procedure, given my health?
- Will you use the wrist or the groin, and why?
- If you find a narrowing, will you treat it in the same sitting, and how will you decide?
- How should I manage my blood thinners, diabetes medicines and other tablets around the procedure?
- What will the result change about my treatment, and what happens if the arteries look normal?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I be awake during the angiogram?
Is a coronary angiogram dangerous?
How is this different from a CT coronary angiogram?
Will I have a stent at the same time?
When can I drive and get back to normal?
Is it available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Cardiac catheterisation and coronary angiography NHS — Coronary angiography: risks NHS — Coronary angiography: how it's performed British Heart Foundation — Tests for heart conditions NICE — Recent-onset chest pain of suspected cardiac origin (CG95)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: CT coronary angiogram · Angioplasty and stenting · Heart bypass surgery · Myocardial perfusion scan (nuclear cardiology) · Cardiac MRI