Coronary angiogram: what to expect
Last reviewed: October 2026
A coronary angiogram is the most detailed way to look at the arteries that supply your heart. It shows exactly where any narrowings are and how severe they are, so we can decide together whether you need medicines, a stent or bypass surgery.
What is a coronary angiogram?
A coronary angiogram is an X-ray test of the heart arteries. A thin, flexible tube called a catheter is passed from an artery in your wrist up to the heart. A small amount of contrast dye is injected through the catheter, which makes the arteries visible on X-ray.
The pictures show how blood flows through each artery and whether any are narrowed or blocked by fatty plaque. It is sometimes called cardiac catheterisation.
Why you might need one
Chest pain or angina
Symptoms that suggest a narrowed heart artery, especially if they limit your daily life.
Abnormal test results
A CT scan, stress test or MRI that shows narrowing or reduced blood flow to the heart.
Planning treatment
Before a stent, bypass surgery or heart valve surgery, to map the arteries precisely.
An angiogram is also used to investigate breathlessness, unexplained heart failure, or a heart attack.
CT or invasive angiogram?
Both tests look at the heart arteries, but they answer slightly different questions. The right first test depends on your symptoms and how likely it is that you will need treatment.
| CT coronary angiogram | Invasive coronary angiogram | |
|---|---|---|
| How it is done | A scan, with dye given through a drip in the arm | A catheter passed from the wrist to the heart |
| Best for | Finding or ruling out disease when the diagnosis is uncertain | Measuring the severity of narrowings and treating them |
| Treatment at the same time | No | Yes, a stent can often be placed in the same procedure |
| Time | About 15 minutes | Half a day in hospital |
Many patients start with a CT coronary angiogram as part of a heart health check or chest pain assessment, and go on to an invasive angiogram only if the scan shows significant narrowing.
Whether CT can also replace invasive angiography as the first test for patients with a high likelihood of coronary disease is being tested in the INCHARGE trial, for which I am the Royal Papworth site lead.
Preparing for your angiogram
- Blood tests: to check your kidney function and blood count beforehand.
- Eating and drinking: you will be given specific instructions. Usually you can have a light breakfast and keep drinking water.
- Blood thinners: tell us if you take warfarin, apixaban, rivaroxaban, edoxaban or dabigatran. These may need to be paused for a short time. Keep taking aspirin unless told otherwise.
- Diabetes: tablets such as metformin, and insulin doses, may need adjusting around the procedure.
- Allergies: let us know about any previous reaction to contrast dye or iodine.
- Getting home: arrange for someone to drive you home and, ideally, to stay with you overnight.
On the day
- Admission. A nurse checks your observations and medicines, and I go through the procedure with you and answer any questions before you sign the consent form.
- Local anaesthetic. You lie on the X-ray table, awake. The skin over the artery at your wrist is numbed. A mild sedative is available if you feel anxious.
- The pictures. The catheter is guided to the heart and dye is injected into each artery in turn while X-ray images are taken from different angles. You may feel a brief warm flush. The procedure usually takes 20 to 40 minutes.
- Extra measurements, if needed. If a narrowing is borderline, a fine pressure wire can measure how much it restricts blood flow. Imaging from inside the artery (IVUS or OCT) can show the plaque in detail.
- Finishing. The catheter is removed and a tight band is placed around your wrist to seal the artery. The band is gradually loosened over a couple of hours.
The wrist (radial) approach is used for almost all procedures because it lets you sit up and walk soon afterwards. The groin is used only occasionally.
Results and next steps
I will discuss the findings with you on the same day, usually before you go home. There are three broad outcomes:
- No significant narrowing: reassurance, with advice on reducing your long-term risk.
- Narrowing suitable for a stent: this can often be treated in the same procedure, if we have discussed it beforehand and you have agreed. Otherwise it is planned for another day.
- More complex disease: for example several narrowed arteries or a completely blocked artery (CTO). Treatment options are discussed with you and, where appropriate, with the cardiac surgeons in a heart team meeting.
Risks
A coronary angiogram is a common, low-risk procedure. Serious complications such as stroke, heart attack, emergency surgery or death occur in fewer than 1 in 1,000 procedures. Your individual risk depends on your general health and is discussed with you beforehand.
Less serious problems include:
- bruising or a small swelling at the wrist, which settles over a week or two
- a temporary blockage of the wrist artery, which is usually harmless because the hand has a second blood supply
- an allergic reaction to the contrast dye
- strain on the kidneys from the dye, mainly in people who already have reduced kidney function
- an irregular heartbeat during the procedure, which usually settles on its own
Recovery
- Going home: most people go home the same day, a few hours after the procedure.
- Your wrist: keep it dry for 24 hours and avoid heavy lifting with that arm for about a week.
- Driving: you cannot drive yourself home. Most hospitals advise waiting a few days for the wrist to heal. If you have a stent, DVLA guidance for car and motorcycle licences is not to drive for at least one week.
- Work: most people return to desk-based work within a few days.
Contact the hospital or your GP if the wrist becomes increasingly swollen, painful or bleeds. Call 999 if you develop chest pain that does not settle.
Questions patients ask
Is a coronary angiogram painful?
Most people find it much easier than they expected. You will feel a sting from the local anaesthetic, and some people feel a warm flush when the dye is injected, but the tubes inside the arteries cannot be felt.
How long does a coronary angiogram take?
The procedure itself usually takes 20 to 40 minutes. With preparation and recovery, most people are in hospital for half a day and go home the same day.
Will I be awake?
Yes. The procedure is done under local anaesthetic, and a mild sedative is available if you feel anxious. Being awake means you can watch the screens and we can talk through the findings as we go.
When can I drive after a coronary angiogram?
You cannot drive yourself home. Most hospitals advise waiting a few days for the wrist to heal. If you have a stent during the same procedure, DVLA guidance for car and motorcycle licences is not to drive for at least one week.
Should I have a CT coronary angiogram or an invasive angiogram?
A CT coronary angiogram is often the best first test when the diagnosis is uncertain. An invasive angiogram is preferred when symptoms are typical or severe, when treatment such as a stent is likely, or when a CT scan has already shown significant narrowing.
Does private medical insurance cover a coronary angiogram?
Most UK insurers cover coronary angiography when it is clinically indicated, usually after a GP referral and a consultation. Check your policy and obtain pre-authorisation before the procedure.
Fees
For self-funding patients, the fee depends on whether any treatment is needed during the procedure. A written quote covering the hospital and consultant fees is provided before you go ahead.
Coronary angiogram (self-pay): [£ — or "available on request"]
Where: [Royal Papworth Hospital private patients unit — confirm]
Book a consultation
Dr Tom Kaier is a Consultant Interventional Cardiologist at Royal Papworth Hospital. He sees self-funding and insured patients on the Cambridge Biomedical Campus.
View booking optionsThis page provides general information and is not a substitute for individual medical advice. If you have chest pain at rest, or chest pain that does not settle, call 999.
Written and reviewed by Dr Thomas Kaier MD MRCP(UK) MBA PhD, GMC No. 7025841.
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