title: [Coronary angiography: 1st or 2nd-line test?].
abstract: Coronary angiography, although now performed extremely frequently, remains an invasive and expensive examination, whose place, as first-line diagnostic 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 disease; concomitant evaluation of left ventricular function by associated radiological ventriculography). However, it is unable to precisely assess the degree of coronary wall disease and, more importantly, cannot evaluate the functional repercussions of stenosis. Under these conditions, only cases in which myocardial revascularization is expected to provide 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 "mapping" 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 myocardial revascularization should be based: the "oculostenotic reflex" must always be avoided.
authors.affiliation: Service de Cardiologie, CHU de Nancy-Brabois, Vandoeuvre-Les-Nancy.
authors.forename: N
authors.initials: N
authors.lastname: Danchin
authors.forename: M
authors.initials: M
authors.lastname: Angioi
authors.forename: I
authors.initials: I
authors.lastname: Abdel Fattah
authors.forename: L
authors.initials: L
authors.lastname: Jacquemin
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000009:adverse effects; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging
vernacular_title: La coronarographie: examen de premiére ou de deuxième intention?