The cardiac catheterization laboratory is the location where nonsurgical invasive cardiology procedures are performed. These include diagnostic cardiac catheterization, percutaneous coronary artery intervention (or angioplasty), percutaneous valvular therapy, and peripheral vascular interventions. Charles J. Davidson, MD is the medical director of the Bluhm Cardiovascular Institute's Center for Coronary Disease, chief of the Cardiac Catheterization Laboratories, and director of the Interventional Cardiology Program.
The cardiac catheterization laboratory, under the directorship of Dr. Davidson since 1993, has become one of the premier invasive cardiology programs in the country. Both established and new cutting-edge technologies are utilized in the cardiac catheterization laboratory. In addition, numerous clinical research trials are ongoing to evaluate new therapies for the nonsurgical treatment of coronary and valvular heart disease.
The Bluhm Cardiovascular Institute compared internal clinical patient outcome data to outcome data from the American College of Cardiology - National Cardiovascular Data Registry (1999), National Heart, Lung, and Blood Institute Registry on Percutaneous Coronary Artery Intervention (2000), the National Registry of Myocardial Infarction (2000), and to a study of combined outcomes from 233 clinical research trials (2003)1. This allowed us to determine how we are performing in comparison to the outcome data from centers throughout the country.
Cardiac Catheterization Laboratory Volume
It is widely accepted that physician experience leads to improved
clinical results for the patient. Physician experience is expressed in
a number of factors. No one factor can be looked at in isolation. These
factors include but are not limited to medical training, years in
practice, and the volume (or number) of procedures performed within a
certain time period.
At the Bluhm Cardiovascular Institute's Cardiac Catheterization Laboratory, diagnostic cardiac catheterization and percutaneous coronary artery intervention procedures have doubled in volume within the last 10 years. Physicians performing procedures in the cardiac catheterization laboratory are board certified in interventional cardiology and general cardiology and have a dedicated focus in invasive cardiology procedures. Practice has been standardized among physicians to insure excellent outcomes that compare favorably to national published databases and clinical research trials.
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Diagnostic Cardiac Catheterization
Diagnostic cardiac catheterization is the gold standard test for diagnosing coronary and valvular heart disease. A diagnostic cardiac catheterization
is an X-ray exam of the heart and its arteries. The exam looks at how
well the heart and its valves are working. The test helps detect valve
dysfunction and identifies blocked coronary arteries.
During the exam, a thin catheter (tube) is inserted in the femoral artery (in the groin) and slowly passed to the heart. Dye (contrast) is injected and X-rays are taken. The contrast allows the heart and blood vessels to be seen. The exam involves little or no discomfort and lasts one to two hours.
One of the risks for all cardiac catheterization procedures is mortality (or death) of the patient. At the Bluhm Cardiovascular Institute there have been no cardiac deaths related to the performance of a diagnostic cardiac catheterization. This includes over 8,000 patients treated during this timeframe.
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In addition, there have been no myocardial infarctions (or heart attacks) in patients undergoing diagnostic cardiac catheterization.
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Vascular complications are usually considered the most common complication following diagnostic cardiac catheterization. At the Bluhm Cardiovascular Institute, there has been approximately a 1 in 1000 incidence of major vascular complications in patients undergoing a diagnostic cardiac catheterization. This is in contrast to the American College of Cardiology - National Cardiovascular Data Registry data, where this complication was noted in 4 in 1000 patients. Vascular complications include bleeding from the groin puncture site that may require additional therapy such as a blood transfusion.
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In addition, the incidence of a neurologic complication occurring during a diagnostic cardiac catheterization compares favorably to that repeated in the American College of Cardiology - National Cardiovascular Data Registry. Neurologic complications are defined as stroke and transient ischemic event.
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Percutaneous Coronary Artery Intervention for Coronary Artery Disease
Percutaneous coronary artery intervention is a non-surgical technique
that has improved in safety and durability and is often an alternative
to the more invasive coronary artery bypass surgery for the treatment
of patients with coronary artery disease. Percutaneous coronary artery
intervention is performed by inserting a small tube (catheter) with a
balloon tip into the narrowed coronary artery. The balloon is slowly
inflated to open up the coronary artery. At this time, a small metal
coil (stent) may be inserted to keep the narrow artery open.
The use of drug-eluting stents has markedly increased the short and long-term success of percutaneous coronary artery intervention for the treatment of patients with coronary artery disease. Physicians at Bluhm Cardiovascular Institute's Cardiac Catheterization Laboratory were the first in Chicago to utilize drug-eluting stents for the treatment of coronary artery disease. Investigators at the Institute were instrumental in the pivotal clinical research trials that lead to approval of the two drug-eluting stents now available in the United States.
The outcomes data for patients undergoing percutaneous coronary artery intervention at the Bluhm Cardiovascular Institute were compared to two national registries - the American College of Cardiology, National Cardiovascular Data Registry and the National Heart, Lung, and Blood Institute Registry on Percutaneous Coronary Intervention. The incidence of mortality (or death) at the Bluhm Cardiovascular Institute following percutaneous coronary artery intervention was substantially less than what has been reported in both national registries. This includes over 2,500 patients treated during this timeframe.
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The need for emergency coronary artery bypass surgery due to unsuccessful angioplasty has been dramatically reduced by the use of drug eluting stents. Once again, in comparison to national registries, the Bluhm Cardiovascular Institute performed at exemplary levels.
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The Bluhm Cardiovascular Institute demonstrates a low incidence of myocardial infarction (or heart attack) occurring during percutaneous coronary artery intervention as compared to data reported in two national registries.
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Percutaneous Coronary Artery Intervention for Myocardial Infarction
Special subsets of patients undergoing percutaneous coronary artery
intervention are those presenting to the Bluhm Cardiovascular Institute
with acute myocardial infarction (or heart attack). It has been
demonstrated in multiple clinical research trials that the performance
of percutaneous coronary artery intervention at the time of acute
myocardial infarction saves lives and is a more effective and a safer
treatment than the use of thrombolytic therapy alone for patients
presenting with an acute myocardial infarction. Because the physicians
at the Bluhm Cardiovascular Institute understand these concepts,
percutaneous coronary intervention has been provided for all patients
presenting with an acute myocardial infarction for the past 12 years.
Percutaneous coronary artery intervention is available at the Bluhm
Cardiovascular Institute 24 hours a day, seven days a week.
The outcomes of patients presenting to the Bluhm Cardiovascular
Institute undergoing percutaneous coronary artery intervention for
acute myocardial infarction have been compared to the National Registry
of Myocardial Infarction and/or to a study of combined outcomes from
233 clinical research trials. The incidence of mortality (or death)
within Bluhm Cardiovascular Institute following this procedure is
exceedingly low and compares favorably with patient outcome data
reported in the National Registry of Myocardial Infarction and the 233
combined research clinical trials.
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1. Keeley, et al. Lancet 2003; 361:13-20.
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