Coronary Angiograptiy : No Longer The- Gold Standard?

Abstract

Despite tremendous advances in noninvasive cardiac diagnosis, Coronary
remains the only means of looking at Coronary anatomy in the living patie obstructive lesions seen in this manner have been classified as a percentage lumen profile diameter compared tQ the normal adjacent coronary lumen.

Over the years, this “Gold Standard” of determining the significance of coronary lesions has been seriously questioned. First came the autopsy studies which showed a consistent under-estimation of Coroncziy narrowing by angiography even when the arteries were fixed under pressure. This was tnair1y because a large number ofpatients have diffuse disease. Therefore, in reality a more diseased area was being compared to a less diseased area ra ther than the diseased area versus completely normal vessel.

As if the above was not enough of a limitation of coronary Angiograpgy, think of  the fact that a third of the lesions resulting in the ultimate complication of coronary disease, i.e acute myocardial infarctionare those that would be classified as hemodynamically not significant, i.e, not capable of  even producing ischemia, leave aside infarction!