CORONARY ANGIOGRAPHY - FIRST-LINE OR SECO ND-LINE EXAMINATION

Coronary angiography, although now performed extremely frequently, rem ains an invasive and expensive examination, whose place, as first-line dignostic method, must be discussed; its main advantage is to provide a definitive diagnosis of coronary atherosclerosis as well as simple prognostic indicators (single vessel, two-vessel or three-vessel disea se; concomitant evaluation of left ventricular function by associated radiological ventriculography). However, it is unable to precisely ass ess the degree of coronary wall disease and, more importantly, cannot evaluate the functional repercussions of stenosis. Under these conditi ons, only cases in which myocardial revascularization is expected to p rovide a definite clinical benefit (presence of frank angina symptoms) probably justify first-line coronary angiography. In all other cases, coronary angiography is a useful examination to provide reference ''m apping'' of the coronary lesions, but an obvious clinical benefit for the patient cannot be expected from systematic use of this technique. In particular, in such situations, coronary angiography should not be the only element on which the decision to perform myocardia[ revascula rization should be based: the ''oculostenotic reflex'' must always be avoided.