Evaluation of coronary artery disease.

In this issue of JAPI there are two articles on the evaluation of suspected or known coronary artery disease : comparison of stress ECG and stress myocardial perfusion imaging (MPI), and adenosine stress MPI. This is a good opportunity to review the subject of evaluation of Coronary Artery Disease (CAD). The views expressed are based on my personal experience of 25 years in nuclear cardiology and an extensive review of world literature over the last 30 years, including proceedings of the 6th International Conference on Nuclear Cardiology in Florence (April 27 30, 2003), which represents a cumulative experience of 10,000 patients in 17 different countries worldwide. Coronary artery disease has assumed epidemic proportion in India, affecting all socioeconomic groups; it is more extensive and severe in Indians and occurs 10 years earlier than in the rest of the world population. Hence the cost-effectiveness and costbenefit ratio of tests employed for the early detection of CAD, risk stratification for management planning, and follow-up of medical therapy as well as aggressive revascularization therapy, assume great importance, not only for the patients and clinicians but also for hospital administrators, insurance companies and third party health care providers and health care policy planners.