American College of Cardiology

A. Organization of Committee and Evidence Review

The Writing Committee consisted of acknowledged experts in cardiac catheterization representing the American College of Cardiology (9 members) and the Society for Cardiac Angiography and Interventions (2 members). Both the academic and private practice sectors were represented. The document was reviewed by 3 official reviewers nominated by the ACC, the ACC Cardiac Catheterization and Intervention Committee, the Diagnostic and Interventional Catheterization Committee of the Council on Clinical Cardiology of the American Heart Association, the Society for Cardiac Angiography and Interventions, and 12 content reviewers nominated by the Writing Committee. The document was approved for publication by the ACC Board of Trustees and the SCA&I Board of Trustees in April 2001 and endorsed by the American Heart Association and the Diagnostic and Interventional Catheterization Committee of the Council on Clinical Cardiology of the AHA. This document will be considered current until the Task Force on Clinical Expert Consensus Documents revises or withdraws it from distribution.

B. Purpose of This Expert Consensus Document

Cardiac catheterization settings and procedures have evolved since publication of the ACC/AHA Guidelines for Cardiac Catheterization and Cardiac Catheterization Laboratories in 1991 ⁽⁵⁾. Whereas outpatient cardiac catheterizations were infrequent then, now almost all elective diagnostic cardiac catheterizations are performed on an outpatient basis. The setting for performance of cardiac catheterizations has expanded to include not only traditional medical centers with a cardiovascular surgical program, but also community hospitals without cardiovascular surgical backup and now some freestanding laboratories. The risks associated with both diagnostic and interventional cardiac catheterization have declined so markedly that older restrictions regarding the study of even higher-risk patients deserve reassessment. Now it is rare to perform interventional procedures with an empty operating room on standby and a surgical team on full alert. Indeed, the safety of such interventional procedures is even being examined in hospital settings without cardiovascular surgical facilities. The driving forces behind some of these changes have raised concerns among the cardiology community, however, so the time seems appropriate to evaluate these potential ethical issues. Equipment is also rapidly evolving, especially in the imaging arena. With the impetus provided by the universal acceptance of the DICOM standards for cardiac angiography, cinefilm is rapidly being replaced by compact discs and computerized archiving systems. More changes, such as the expanded use of the Internet, are imminent. Furthermore, “ad-hoc” catheter revascularization is increasingly being performed immediately following the diagnostic angiographic procedure. The pediatric cardiac catheterization suite is also evolving from a purely diagnostic laboratory to an interventional laboratory.