How often we can treat CAD , effectively without doing a coronary angiogram ?
March 23, 2026 by dr s venkatesan
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.