Over the last half century, cardiac catheterization
laboratories have evolved from highly specialized research
laboratories into heavily used procedure rooms in which
an extensive array of diagnostic tests and therapeutic
interventional procedures are performed on millions
of patients yearly. Catheterization laboratories were
first used to define the hemodynamic features of complex
congenital and acquired valvular heart disease. The
development of cardiopulmonary bypass expanded the potential
for surgical correction in many of these patients. As
surgical programs grew, catheterization laboratories
likewise proliferated.
With the advent of selective coronary angiography in
the late 1950s, physicians began to explore the possibility
of identifying and quantifying the extent of coronary
artery disease. Catheterization laboratories were few
and largely limited to major academic medical centers.
By the late 1960s the use of aorto-coronary bypass surgery
was quickly expanding throughout the country, and the
acceptance of surgical revascularization promoted the
proliferation of cardiac catheterization laboratories.
The decade of the 1970s was characterized by substantial
improvements in imaging systems and catheterization
supplies and methods. Preformed catheters, introduced
by Drs. Judkins and Amplatz, facilitated safe and expeditious
catheterization from the femoral route and rapidly became
more popular than the brachial approach pioneered by
Dr. Mason Sones. Although laboratories were disproportionately
located in major medical centers with cardiac surgical
programs, the improved safety and simplicity of diagnostic
procedures fostered the proliferation of diagnostic
laboratories in community hospitals in which cardiac
surgery programs did not exist. These hospitals retained
close ties to tertiary centers where patients could
be easily referred or transferred for surgical procedures.
During this period the National Institutes of Health
funded several Myocardial Infarction Research Units
(MIRUs) at select academic medical centers. It was in
the context of MIRU research that the safety of cardiac
catheterization in the setting of an acute myocardial
infarction (MI) was first demonstrated.
The late 1970s heralded a major change in the practice
of invasive cardiology. The introduction of intracoronary
thrombolysis and subsequently percutaneous transluminal
coronary angioplasty (PTCA) forever changed the character
of the catheterization laboratory. What was previously
only the setting for diagnostic testing became a therapeutic
laboratory where patients with both stable and unstable
coronary syndromes and valvular and congenital heart
disease could be treated. The introduction of percutaneous
balloon valvuloplasty procedures in the mid and late
1980s and advances in interventional procedures in the
pediatric catheterization laboratory further expanded
the range of therapeutic options. Because of the potential
for catastrophic complications, especially with interventional
procedures, these methods were appropriately confined
to laboratories with immediate surgical backup.
The last time the ACC/AHA Task Force on Practice Guidelines
developed a general document for cardiac catheterization
laboratories (5),
the majority of the workload in most laboratories consisted
of diagnostic cardiac catheterization procedures. Computerized
recording methods and digital angiography were considered
research ventures, and most cardiac catheterization
procedures were performed on inpatients. However, the
use of balloon angioplasty was rapidly increasing, and
the 1990s heralded the evolution of second-generation
coronary therapeutic devices, including several coronary
atherectomy and laser catheters, followed by the widespread
use of coronary artery stents. Improvements in the quality
of imaging equipment, new potent antiplatelet agents,
and further improvements in coronary stent technology
resulted in a high degree of safety for most interventional
procedures. Furthermore, the majority of routine diagnostic
cardiac catheterizations performed shifted to the outpatient
setting.
Cardiac catheterization laboratories have further evolved
into multipurpose facilities. Improvements in x-ray
systems and the development of digital processing capabilities
have facilitated “noncardiac” vascular investigations
and interventions in other areas of the vascular system.
At select centers, in addition to cardiac disease, cardiologists
are now involved in the diagnosis and therapy of disease
involving the peripheral, renal, and carotid vasculature.
