CAD is growing as an epidemic in most parts of the globe. It is a major determinant of health status of any country .Great strides in diagnostic, treatment modalities of CAD have been made in the last few decades. Still , the core principle of management of CAD resides in simple things like risk factor reduction / optimization , life style changes and few essential cardio-protective medications Aspirin, beta blockers and statins.
However , modern scientists have made a firm statement that knowing the coronary anatomy before starting the treatment is the only scientific approach . It is a huge assumption !
Is it practical ? or is it really required ?
CAD can be managed by means of medicines , interventions or surgery. Revascularisation is required only for those , who have critical , symptomatic lesions.
It is estimated , in only a fraction of CAD patients , we would require to know the anatomy . We have set criteria to choose patients for CAG , who are likely to have critical lesions.Physicians are trained for that elusive wisdom to choose such patients .Standard text books do mention clear-cut Indications for doing CAGs. Unfortunately , it is least respected and followed .
Cardiac physicians who would boast they can’t treat a CAD without knowing the coronary anatomy are clinically handicapped or poorly trained.
I am afraid such a class of cardiologists are rapidly breeding in the country side. They are encouraged to attend CME on clinical cardiology and basic principles of clinical decision-making .
We can’t keep on doing CAGs like ECG for every episode of angina . In fact treating CAD without knowing the anatomy remains (And it should be ) the dominant theme contemporary clinical practice . CAG is multi -edged sword
The most important side effect of routine coronary angiogram is , it ends up in infinite number of inappropriate interventions !
I think , we should pray in Hippocratic temples for sufficient wisdom to choose our patients. We can also learn it from Neurologists , they somehow manage most forms of cerebrovascular diseases (scientifically too ! ) without asking for angiogram of circle of Willis ! Mind you. . . brain is equally a vital organ !
Final message
It needn’t be a crime to treat CAD* without knowing the coronary anatomy. Rather . . . it would be so , to ask for CAG indiscriminately , in every episode of chest pain , without applying clinical sense !
* Emergencies included.
Dr.S.Venkatesan MD 