The American Heart Association recommends a coronary angiogram for any patient who has previously undergone tests such as a cardiac stress test, the results of which suggest severe coronary artery disease, especially if additional risk factors are present. A stress test compares the results of a patient's electrocardiogram (EKG, ECG) while at rest to their EKG during and after the heart being under stress. If a patient has severe symptoms such as chest pain (angina), at rest or with minimal exertion, an angiogram is usually recommended.

Angiograms are most commonly used to confirm the presence of coronary artery disease, but because the symptoms of heart disease often do not present themselves until the disease is well progressed, any patient experiencing angina or shortness of breath may be a candidate for a diagnostic angiogram.

Patients with previously diagnosed symptoms of cardiovascular disease whose symptoms have not been controlled with medicine or drug therapy, or whose chest pain and shortness of breath have begun to affect their daily lives, are candidates for an angiogram.

Patients with confirmed severe cardiovascular disease routinely undergo an angiogram procedure to determine whether coronary bypass surgery or an angioplasty are the appropriate next steps in the treatment of their disease.

Risk factors increasing the advisability of an angiogram include smoking, high blood pressure, high cholesterol and diabetes.

Patients in occupations involving the safety of others (pilots, bus drivers, etc.), or who are otherwise considered to present special risks should they have a heart attack are also candidates for an angiogram.