Background
Coronary angiography (CA) remains the gold standard for the anatomical assessment of coronary artery disease (CAD). Despite rapid advances in non-invasive imaging modalities, invasive coronary angiography continues to play a pivotal role in the diagnosis, risk stratification, prognostication, and management of cardiovascular diseases. This systematic review evaluates the predictive and prognostic utility of coronary angiography across a broad spectrum of cardiovascular disorders.

Objectives
This study aimed to explore published evidence on the diagnostic, predictive, and prognostic value of coronary angiography in patients with cardiovascular diseases.

Methods
A systematic literature search was conducted to identify studies examining the predictive and prognostic value of coronary angiography in patients with cardiovascular diseases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Searches were performed across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library for relevant publications issued from January 2005 through December 2025. Studies were considered eligible when they comprised randomized controlled trials, prospective or retrospective cohort investigations, or registry-based analyses that assessed relationships between coronary angiographic characteristics and clinical outcomes. The outcomes of interest included all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, repeat revascularization, arrhythmias, and major adverse cardiovascular events (MACE). Extracted evidence was synthesized narratively to provide an overview of the predictive and prognostic relevance of angiographic findings across diverse populations with cardiovascular disease.

Results
Fifty-four studies involving more than 410,000 participants were included. Evidence consistently demonstrated that angiographic severity, lesion complexity, multivessel disease, left main coronary artery involvement, and high SYNTAX scores were significant independent predictors of adverse cardiovascular outcomes. Coronary angiography provided substantial prognostic information beyond clinical variables, improving risk stratification and therapeutic decision-making. However, anatomical severity alone did not always correlate with ischemic burden or plaque vulnerability, emphasizing the importance of integrating physiological assessment and intracoronary imaging.

Conclusion
Coronary angiography remains an indispensable prognostic tool in cardiovascular medicine. Its predictive value is significantly enhanced when combined with physiological measurements, intracoronary imaging, biomarkers, and clinical risk scores. Future research should focus on artificial intelligence-assisted angiographic analysis and multimodal precision cardiovascular risk prediction.

Keywords: Coronary angiography, coronary artery disease, prognosis, prediction, cardiovascular disease, major adverse cardiovascular events, systematic review.