Dr. Boden is the Principal Investigator of the COURAGE Trial, which found that in chronic stable angina patients, optimal medical therapy was equivalent to PCI plus optimal medical therapy.

What is the size of your cath lab facility and number of staff members? Our facility currently has four cath labs, one of which is a swing lab. We have thirteen full-time staff members working in our cath labs (not counting prep/recovery staff). Currently on staff are: • Two cardiovascular technologists (all with pending RCIS certifications); • Three radiology technologists (RTs); • Eight registered nurses (RNs).

Part II: Normal Values/Waveforms and Attention-getters

We knew that percutaneous coronary intervention (PCI) did not prolong life, but relieved symptoms. Was the result of this study a surprise? The results were not all that surprising. We have known for years that chronic stable angina patients have an excellent prognosis. The Framingham trial began to track patients well before many of the current drugs available to treat patients were out on the market. The average annual mortality for a patient with chronic stable angina was about 4% in the Framingham data. If mortality is only 4%, it will be difficult to find a therapy that makes a substantial difference in that number. If you look at more recent trials that have tracked similar outcomes, the average mortality rate is even lower, and the adverse cardiac event rate is also very low. Against these results, the findings of COURAGE are not all that surprising. Most would probably have predicted that in the group with chronic stable angina, angioplasty would not be superior to medi

This monthly column in Cath Lab Digest reviews important points of distinction with drug-eluting stents, from characteristics to interventional techniques, to provide valuable and relevant information about this technology. This article, the first of a two-part series on drug-eluting stent (DES) outcomes, focuses on the use of intravascular ultrasound (IVUS) during an angioplasty procedure.

Abstract. Measured oxygen consumption rates (VO2) are being used less frequently for direct Fick cardiac output determinations during cardiac catheterization because the instruments that measure VO2 are usually cumbersome, expensive and difficult to use. A small, inexpensive VO2 device recently became available. Therefore, the aims of this report are: (1) to delineate the advantages and limitations that would affect its use during cardiac catheterization; (2) to define the patient population in which its use would be safe and effective; and (3) to estimate the accuracy of cardiac output determinations based on its VO2 measurements. The MedGem® is a fist-size device that measures VO2 as a patient breathes through it using either a facemask or mouthpiece. We evaluated it by measuring the external deadspace it imposes on the patient, by measuring the time required for each measurement, by determining its precision from repeated measurements on healthy volunteers and animals, and b

Bring the Cardiovascular Review Exam Course to your cath lab!

The 8th Annual Conference of the National Society of Radiology Practitioners Assistants (NSRPA) was held January 28-30, 2007, at the Orleans Casino and Hotel in Las Vegas, Nevada. The meeting, which was extended to three days for 2007, featured 15 speakers and four workshop hosts. Certified advanced-level practicing radiology practitioner assistants (RPAs) now number 305 in the United States, with at least 60 RPAs working in cardiac catheterization laboratories.

Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest@aol.com.

While monitoring during cases, we notice that the compensatory and non-compensatory pauses create different pressure levels. Why is this? —RCIS Review Course Participant

Later this year, it will be the 30th anniversary of the first cath lab percutaneous transluminal coronary angioplasty (PTCA), performed by Dr. Andreas Gruentzig in 1977 in Zurich, Switzerland.

Coronary artery disease (CAD) is a systemic problem which requires systemic treatment. The recent New England Journal of Medicine study from the COURAGE Trial investigators, discussed in this issue of Cath Lab Digest in detail by the Principal Investigator, Dr. Bill Boden, and by the current president of the Society of Cardiovascular Angiography & Interventions (SCAI), Dr. Gregory Dehmer, found that death and myocardial infarction (MI) was not reduced by percutaneous coronary intervention (PCI) compared to optimal medical therapy over 5 years.

Always be a teacher. When a person is observing in the lab, whoever they are, take the time to explain what is going on throughout the procedure.

SICP Legislative Update: CARE Bill March 30, 2007, Washington, D.C. — Senators Enzi, Kennedy Introduce 2007 CARE Bill

SICP Editor’s note: Shirly is an active member of the Oregon Chapter of the SICP (Society of Invasive Cardiovascular Professionals) and will be writing a series of articles about teamwork. We hope you enjoy her work.

Chapter news from around the country.