The practice
Dr. Gill practises interventional cardiology at Oxford Hospital in Jalandhar, Punjab, India, alongside the management of diabetes and metabolic disease. The interventional scope is complete — primary and complex angioplasty, radial access, peripheral intervention, pacemaker and defibrillator implantation, catheter-based closure of structural defects, and the full range of echocardiography.
What distinguishes the practice is not which procedures are available but the standard applied to whether they are warranted. In stable coronary disease, that standard is drawn from the randomised literature rather than from convention: a procedure is offered when the evidence shows it will achieve something for that particular patient, and medical therapy is pursued properly when it will not.
Why the conservative position is the demanding one
It is often assumed that not stenting is the easier path. In practice the reverse is true. Placing a stent is a defined event with a clear endpoint. Managing the same patient medically means titrating statin therapy to a lipid target, getting blood pressure to goal, controlling glucose, negotiating tobacco cessation, arranging structured exercise, and then following up often enough to know whether any of it worked.
That regimen is what the stent was measured against in COURAGE, ISCHEMIA and REVIVED-BCIS2, and it is the reason those trials read as they do. The finding is not that stents are ineffective — it is that well-delivered medical therapy is very effective, and the trials were fair to it.
What a consultation looks like
Patients frequently arrive after an angiogram elsewhere, having been told a stent is needed, and wanting to understand whether that is true for them. Those consultations begin with the images and the reports rather than the recommendation: what are the symptoms, is there objective ischaemia, does the lesion restrict flow, and has medical therapy been given a genuine trial?
The aim is for a patient to leave understanding not only what is being advised but why — including, where relevant, that they are being offered relief from symptoms rather than an extension of life. Those are different products, and a patient is entitled to know which one is on the table.
Emergencies are treated as emergencies
None of this applies during a heart attack. In ST-elevation myocardial infarction and high-risk acute coronary syndromes, emergency angioplasty is the intervention with the strongest evidence in cardiology, and delay is measured directly in lost heart muscle. Caution in stable disease and urgency in an acute event are the same principle applied to different situations.