Data from the ACC s National Cardiovascular Data Registry CathPCI Registry during the 2012 calendar year included a 1.5% incidence of pro- cedural complications of diagnostic angiography. Complications in earlier reports included death, stroke, myocardial infarction (MI), bleeding, infection, contrast allergic or anaphylactoid reactions, vascular damage, contrast-induced nephropathy, arrhythmias, and need for emergency revascularization.28 32 Complications are more likely to occur in certain patient groups, including those of advanced age (>70 years), and those with marked functional impairment (Canadian Cardiovascular Society class IV angina or New York Heart Association class IV heart failure), severe left ventricular dysfunction or CAD (particularly left main disease), severe valvular disease, severe comorbid medical conditions (eg, renal, hepatic, or pulmonary disease), bleeding disorders, or a history of an allergic reaction to radiographic contrast material.28 32 The risk of contrast-induced nephropathy is increased in patients with renal insufficiency or In deciding whether angiography should be performed in these patients, these risks should be balanced against the increased likelihood of finding critical CAD. The concept of informed consent requires that risks and benefits of and alternatives to coronary angiography be explicitly discussed with the patient before the procedure is undertaken. 