A. Very Often. We don’t really require the anatomical Information. A well performed stress test will tell us the presence and significance of obstructive lesions .
B .Majority of CAD patients will require CAG , as we can’t rely on other non invasive tests.
C.Atleast all ACS need CAG, but many CCS don’t need it.
D . Forget about it .It is unethical or rather blasphemy to treat CAD without knowing coronary anatomy.
Answer.
Even acute STEMI can be managed without initial ( or even permanent) knowledge of coronary angiogram in atleast 70% of pateints.
* It is sad truth, the modality of standalone thrombolysis has been brutally stigmatised and being portrayed as incomplete and Inferior form of treatment in STEMI. It is pity , such a perception is deep rooted in many cardiologsist’s mind inspite of the fact great studies exists to prove treating STEMI without knowing the anatomy( ie prehospital lysis) could beats PCI consistently )
**How often we need CAG in Chornic CAD? You know the answer . If moderen day cardiac Intervetions insist us take a decision based on Physiology, then why do we want to know anatomy?
A stress test, technically is , equivalent to simultaneous multivessel FFR or iFFR . If some one crosses 10 METs in a stress test , whatever the lesion subset, it can be considered net-equivalent for a normal FFR of near unity. (No one has tested this hypothesis, so as of now it is junk science.) Still every experienced cardiologsist would acknowledge the truth in this.
Dr.S.Venkatesan MD 