Coronary arteriography

Abstract

The cardiology committee put forward the following recommendations which they thought might be helpful, particularly to those who were considering starting coronary arteriography. Coronary arteriography should be carried out only in centres where right and left heart catheterization were routine procedures. This inferred that there would be a cardiologist or physician with special experience in cardiology available. The problem of personnel was difficult but in principle there should be a minimum number of operators who actually inserted coronary artery catheters. Ideally, there should be one consultant cardiologist, or consultant radiologist supported by a cardiologist and one junior hospital doctor, probably a senior registrar who was being trained in the technique. As in all procedures with potential risks, there was a minimum number of investigations below which these hazards increased. The committee considered that ideally this figure should not fall below 100 per year at any centre. To minimize the risk at centres starting coronary arteriography the committee suggested that the senior man involved be seconded for a minimum period of 3 mth to a centre where coronary arteriography was part of the daily programme. The trainee should already be well versed in cardiac catheterization so that he could acquire the necessary expertise in coronary arteriography with minimal delay. During this training period he should be an active member of the team and not simply an observer. In all new centres facilities for emergency cardiac surgery should be planned within the same building or building complex, and when cases of above average risk were being investigated the theatre should centres accessible, with a surgeon alerted. In centrec where coronary arteriography is already successfully established but in which there is no theatre adjacent to the haemodynamic laboratory, adequate alternative arrangements for emergency surgery are acceptable. The committee suggested that it would be unwise for a new centre to start coronary arteriography unless it could be envisaged that in the foreseeable future demands would not fall below and would eventually exceed 100 investigations a year. Finally, the usual radiation protection monitoring procedures to deal with radiation hazards should be adopted in a similar way to those recommended for all other investigations involving cardiac catheterization and angiography. These recommendations were prompted by the fact that in December 1973 a letter from one of Her Majesty's coroners was put before the Cardiology Committee of the Royal College of Physicians asking for current views on coronary arteriography in the U.K. and an estimate of the risks involved. The committee discussed this letter on the basis that coronary arteriography was an established technique, and irrespective of the future of coronary artery surgery it had achieved a permanent place in the investigation of cardiac patients.