The revascularization algorithms separately consider “revascularization to improve survival” and “revascularization to improve symptoms.” If, for example, a patient has significant left main stenosis, good evidence supports a recommendation to proceed with revascularization regardless of symptom status. Of course, we would not know about the left main stenosis without imaging of the coronary arteries (invasive or noninvasive). But the guideline does not clearly specify the timing of coronary angiography in the diagnostic or therapeutic process. Perhaps it should, because details of coronary anatomy can significantly influence treatment decisions. On the cost-conscious hand, however, a patient on the catheterization table who is found to have any severe stenosis may well wind up with 1 or more expensive drug-eluting stents, thereby initiating a new cascade of follow-up tests, drug therapies, and further revascularizations. Angiographers refer to this as the “oculostenotic reflex”: see a lesion, place a stent (17). Thoughtfully constructed, evidence-based guidelines, such as those summarized in this issue, may mitigate such practices. Yet, there is something compelling about knowing the anatomy.