Recommendations for training in vascular medicine. American College of Cardiology Peripheral Vascular Disease Committee

On-site digital quantitative coronary angiography: comparison with visual readings in interventional procedures. Implications for decision and quality control

In order to review the morphological criterion for an interventional procedure, diameter stenosis (%DS) of 226 coronary lesions in 200 patients undergoing elective coronary angiography with an option for 'prima vista' angioplasty (pPTCA), was assessed on-site by both visual 'eye balling' (EB) and independent digital quantitative coronary angiography (DQCA) by means of an angiographic workstation. Compared to DQCA, EB overestimated the %DS between 50 and 80% and accounted for the majority of discrepancies with overestimation up to 45%. Concordant estimates of %DS by both methods were observed in only 10 of the total of 226 stenotic segments; in 20 of 226 cases, EB underestimated %DS up to 20%. EB revealed a %DS > or = 60% in 166 stenoses (73.4%), an estimate that led to subsequent pPTCA. However, only 119 (52.6%) of these lesions had a %DS > or = 60% as assessed objectively by DQCA. With regard to the criterion for PTCA 47 of 166 performed pPTCA (28.3%) would not meet the indication criteria based on objective DQCA information. EB and DQCA (+/-5%DS) had concordant results and criteria for pPTCA only in 103 of 166 coronary lesions (62.1%). These results lead to the conclusion that, on-site and on-line DQCA by an independent cardiologist eliminates both under- and overestimation of stenoses as seen with EB. DQCA supports immediate decision-making and appears necessary for reliable evaluation of coronary morphology in an interventional catheterization laboratory setting and may eventually ensure intraprocedural quality control.

Vascular medicine: an alternative approach to arterial disease

The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) is leading a nationwide initiative to develop comprehensive programs that integrate clinical care, education, and research in vascular disease by developing vascular centers designed to provide comprehensive patient care through a multidisciplinary approach. Only a few medical centers have a dedicated vascular medicine specialty. To date, 11 centers nationwide have received NIH support devoted to creating vascular centers and promoting vascular medicine as a specialty. In June 1992, Northwestern University/Northwestern Memorial Hospital received one of these awards. The NIH recognizes the complex medical problems in patients with vascular disease. The resulting necessity for care by multiple physicians has traditionally led to duplication and fragmentation of services. Until recently, vascular surgery programs have focused primarily on the surgical treatment of vascular disease. This approach does not address risk reduction and the diverse care needs of the population of patients with vascular disease.