In modern days, chances of dissection of a coronary artery and sudden death are becoming less, in experienced hands (even then the mortality is supposed to be 2%). I wish to highlight a few other side effects, which are often not anticipated.

1. Contrast nephropathy : Very often, busy family practitioners treating patients of ischaemic heart, on medical line of treatment, suddenly decide, on a crowded practice day, that the patient needs coronary angiography and may be angioplasty thereafter. Since now there are dozens of centres in Mumbai and in the suburbs, where these procedures are done, these patients are sent urgently to centre.
   
   Every year, I see 2-3 patients, whose chronic renal failure (CRF) has increased after this procedure. This is because CRF is a silent disease and many of these patients have hypertension, diabetes, hyper-cholesterolaemia, hyperuricaemia, and over and above that, they smoke and drink and have already got a silent CRF with a raised serum creatinine level of 1.5 mg or more. All such patients, when given a dye injection, can develop a raise in creatinine level, which may push them into a possibility of chronic long-term dialysis. If detected before sending the patient for angiography, the cardiologist can take precautions by including injection of intravenous sodabicarb, which can avoid this mishap.
2. Severe Pruritus and Skin Rash occurring even with the modern ionic and non-ionic contrasts is not uncommon. So often, we persuade the patients to pay extra money for non-ionic contrast, which is not supposed to cause any allergic reactions. Unfortunately, the patient may still get the reaction.
3. In olden days, sandbags were put on the puncture wound in the thigh, for few hours after the procedure. Now this has been replaced by elastocrepe bandage, which is more comfortable to the patient. But while removing this bandage, the superficial skin can come out creating a raw wound in the groin, delaying the resumption of normal activities by a few days.
4. The stent closure still occurs even with the latest medicated stent in around 20% of patients. It can occur up to a period of 6 months and occasionally up to 9 months.
5. Acute stent thrombosis is a life threatening and an unfortunate complication, which may require urgent hospitalisation and management.
6. Finally, recently some reports of increased morbidity and mortality have been cited after the use of combination of aspirin and clopidogrel which is prescribed to these patients for a period of at least six months.