VOL 56 JULY
CirculIation
NO I 1977
AN OFFICIAL JOURNAL oftle AMERICAN HEART ASSOCIATION EDITORIAL
Indications for Coronary Arteriography THERE IS LITTLE DOUBT that the contribution of Mason Sones in developing the technique of selective coronary arteriography stands as one of the significant milestones of modern cardiology. The ability to clearly define the anatomy of the coronary arteries in health and disease, with little risk to the patient, has furthered greatly our understanding of the clinical manifestations of ischemic heart disease and myocardial function. Although a coronary arteriogram cannot indicate unequivocally that clinical manifestations presented by an individual patient are due to the demonstrated disease, the presence of significant disease makes it possible to strongly suspect such a relationship. Defining the extent of vascular involvement contributes to a reasonably reliable prediction of prognosis. Furthermore, selective coronary arteriography has made it possible to select patients in whom aortocoronary bypass grafting should be technically possible. As a result of these advantages, the procedure has enjoyed a widespread and possibly in some centers an indiscriminate use.
There is growing public concern about the accelerating use of this and other procedures in patients. Medical technology is perceived by some to be a substitute for personal medical care with higher costs and sometimes with less patient satisfaction. The escalating cost of medical care has made an evaluation of the indications for the procedure mandatory. Because of many unresolved issues, divergent points of view by competent cardiologists as to the indications for corFrom the Council on Clinical Cardiology, American Heart Association, Dallas, Texas. Address for reprints: Henry D. McIntosh, M.D., Watson Clinic, P.O. Box 1429, Lakeland, Florida 33802
onary arteriography exist. For example, the indications for coronary arteriography in many situations depend on the possibility of coronary bypass surgery being performed. Whether or not surgery is indicated in many cases depends in part on whether or not it is demonstrated that surgery
prolongs life in selected subsets of patients. It will be several years before many of the questions are answered. Even though attitudes regarding the recognition and treatment of coronary artery disease are subject to considerable change, it was thought desirable to develop reasonable "state of the art" guidelines for the indications for coronary arteriography. Therefore, the Executive Committee of the Council on Clinical Cardiology of the American Heart Association, in the summer of 1975, appointed a committee to develop a state of the art paper defining the indications for coronary arteriography. The membership of the committee was carefully chosen to include cardiologists engaged in different types of cardiologic activities. Collectively, the committee is felt to represent the total spectrum of the practice of cardiology. The committee in its deliberations tried to avoid premature judgments which would fail to accommodate to changes in practice patterns that might develop. When possible, the recommendations were based on published data rather than personal opinions. The report of this committee, published elsewhere in this journal, should be useful in guiding the thoughtful physician in the management of the individual patient. HENRY D. MCINTOSH, M.D. Immediate Past Chairman Council on Clinical Cardiology
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Indications for coronary arteriography. H D McIntosh Circulation. 1977;56:1 doi: 10.1161/01.CIR.56.1.1 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1977 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/56/1/1.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ by guest on May 21, 2015
CirculIation
NO I 1977
AN OFFICIAL JOURNAL oftle AMERICAN HEART ASSOCIATION EDITORIAL
Indications for Coronary Arteriography THERE IS LITTLE DOUBT that the contribution of Mason Sones in developing the technique of selective coronary arteriography stands as one of the significant milestones of modern cardiology. The ability to clearly define the anatomy of the coronary arteries in health and disease, with little risk to the patient, has furthered greatly our understanding of the clinical manifestations of ischemic heart disease and myocardial function. Although a coronary arteriogram cannot indicate unequivocally that clinical manifestations presented by an individual patient are due to the demonstrated disease, the presence of significant disease makes it possible to strongly suspect such a relationship. Defining the extent of vascular involvement contributes to a reasonably reliable prediction of prognosis. Furthermore, selective coronary arteriography has made it possible to select patients in whom aortocoronary bypass grafting should be technically possible. As a result of these advantages, the procedure has enjoyed a widespread and possibly in some centers an indiscriminate use.
There is growing public concern about the accelerating use of this and other procedures in patients. Medical technology is perceived by some to be a substitute for personal medical care with higher costs and sometimes with less patient satisfaction. The escalating cost of medical care has made an evaluation of the indications for the procedure mandatory. Because of many unresolved issues, divergent points of view by competent cardiologists as to the indications for corFrom the Council on Clinical Cardiology, American Heart Association, Dallas, Texas. Address for reprints: Henry D. McIntosh, M.D., Watson Clinic, P.O. Box 1429, Lakeland, Florida 33802
onary arteriography exist. For example, the indications for coronary arteriography in many situations depend on the possibility of coronary bypass surgery being performed. Whether or not surgery is indicated in many cases depends in part on whether or not it is demonstrated that surgery
prolongs life in selected subsets of patients. It will be several years before many of the questions are answered. Even though attitudes regarding the recognition and treatment of coronary artery disease are subject to considerable change, it was thought desirable to develop reasonable "state of the art" guidelines for the indications for coronary arteriography. Therefore, the Executive Committee of the Council on Clinical Cardiology of the American Heart Association, in the summer of 1975, appointed a committee to develop a state of the art paper defining the indications for coronary arteriography. The membership of the committee was carefully chosen to include cardiologists engaged in different types of cardiologic activities. Collectively, the committee is felt to represent the total spectrum of the practice of cardiology. The committee in its deliberations tried to avoid premature judgments which would fail to accommodate to changes in practice patterns that might develop. When possible, the recommendations were based on published data rather than personal opinions. The report of this committee, published elsewhere in this journal, should be useful in guiding the thoughtful physician in the management of the individual patient. HENRY D. MCINTOSH, M.D. Immediate Past Chairman Council on Clinical Cardiology
Downloaded from http://circ.ahajournals.org/ by guest on May 21, 2015
Indications for coronary arteriography. H D McIntosh Circulation. 1977;56:1 doi: 10.1161/01.CIR.56.1.1 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1977 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/56/1/1.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ by guest on May 21, 2015
