Selective coronary angiography: 42 years later

A cardiac catheterization laboratory is not just an angiographic suite

When I began my cardiology training in 1965, my instructors in the cardiac catheterization laboratory made it clear to me that many things other than anatomic assessment by angiography could be accomplished in the cardiac catheterization laboratory. For example, at that time cardiac output, pressure gradients, valvar insufficiency, shunts, assessment of contractility, assessment of myocardial blood flow using radioactive techniques, lactate metabolism, and assessment of ventricular function were the principal physiologic parameters measured.

Finding the vulnerable plaque

At a recent Transcatheter Therapeutics meeting in San Francisco the PROSPECT Trial was presented by Dr. Greg Stone. Prospect stands for Providing Regional Observations to Study Predictors of Events in the Coronary Tree. This was a natural history study of atherosclerosis using multi-modality intracoronary imaging to prospectively identify vulnerable plaque. More on this later.

One-stop cardiovascular diagnostic imaging (and radiation dose)

Kefer et al. indicate that "MSCT and MR are useful for the noninvasive detection of coronary artery stenoses on both a segmental and per vessel basis. Because neither technique is 100% accurate, these techniques are not ready yet to replace conventional coronary angiography." In summary, all things considered, a properly done cardiac catheterization with contrast angiography can really be a one-stop shop for diagnostic imaging and therapy of the cardiovascular system, and the radiation dose is acceptable.

What can we learn from diagnostic tests that visualize the coronary arteries?

So far, no one procedure has proved more useful to the cardiovascular specialist than cardiac catheterization and coronary angiography. Coronary angiography is still alive and well and will remain so for many years.