Not necessarily.
Some decisions are made before medicals. The final decision to issue Visas will then be dependent on medicals.
Mind you, you can not rely on ecas.
This is a message from one of the visa offices:
e-Cas is for applications processing within Canada only. Immigration cases being processed in Visa offices outside Canada use a system different from that used to process similar applications in Canada . As a result, the e-Client Application Status (e-CAS) may not reflect the status of cases being processed in another visa office.