Scientifically , the indication for coronary revascularisation should be based on following
- Patient’s symptom ( more specifically angina , dyspnea is less important !)
- Prov0kable ischemia ( A significantly positive stress test )
- Signifcant LV dysfunction with documented viable myocardium & residual ischemia
- A revascularisation eligible coronary anatomy * TVD/Left main/Proximal LAD etc ( *Either 1, 2 or 3 should be present in addition )
- All emergency PCI during STEMI /High risk NSTEMI
Practically ,
A CAD patient may fulfill “Any of the above 5 “ or “None of the above 5” , but , if a coronary obstruction was revealed by coronary angiogram and if he fulfils The 6th criteria , he becomes eligible for revascualrisation
6th criteria
If the patient has enough monetary resources (by self ) or by an insurance company to take care of PCI /CABG *
*The sixth criteria overrides all other criteria in many of the cath labs .Of course , there are few genuine ones still fighting hard , to keep the commerce out , from contaminating cardiology !
Dr.S.Venkatesan MD 