Cath Lab Digest - November 2007 - (Page 5)

5 stent. In fact, such an approach, that of stenting all intermediate lesions, may do worse. Modifying risk factors and adequate medical treatment in such patients is of greater value than the mechanical intervention. It is also gratifying to know that acute coronary syndromes do not frequently occur at the site of nonsignificant stenoses in the DEFER study. The event rates reported reflect the universal effects of atherosclerotic plaque, not an individual lesion propensity for plaque rupture. Dr. Matar correctly indicates that according to current PCI guidelines, documented ischemia is one of the critical indications to perform PCI, especially in patients with atypical chest pain syndromes and intermediate lesions. Of special interest is that in patients with multivessel disease, nuclear perfusion imaging with sestamibi stress testing is less reliable for indicating the functional significance of individual stenoses and cannot reliably assist in the decision-making for the particular territories at risk. FFR can select specific ischemia-associated lesions. As Dr. Matar indicates, patients in the cath lab with multi-vessel disease are the greatest challenge for the interventionalist. FFR can sort out some complex decisions. Why FFR is not as widely used as it could be appears to be for reasons which are as diverse and complex as the PCI physicians. Nonetheless, FFR can be easily incorporated into an interventional practice if the operator has a sufficient understanding of the limitations of angiography, stress testing in multi-vessel disease, and by deciding to put the clinical impact of inappropriate stenting ahead of any economic impact associated with procedure performance. FFR does impart considerable economic saving to laboratory and hospital. An old dictum in stenting was “when in doubt, just stent it,” but this was before the time of our appreciation of the downsides of drug-eluting stents. Now with the rare but catastrophic DES-related complications, the paradigm shift to “when in doubt, check the lesion before drug-eluting stenting” appears to be sage advice. It is my and Dr. Matar’s belief that the use of FFR in clinical practice should be a routine part of the interventionalist toolbox. Dr. Matar’s discussion of this practice focuses our thinking about being a complete interventionalist. ■ Now with the rare but catastrophic DESrelated complications, the paradigm shift to “when in doubt, check the lesion before drug-eluting stenting” appears to be sage advice. The limitations for such a study included the non-universal use of drugeluting stents and operator-selected use of clopidogrel, since this was not standard care over the study period. However, neither of these two factors changes the important clinical message that an intermediate lesion which is physiologically normal has a predictable clinical course, like that of any coronary atherosclerosis patient. Furthermore, these patients do not benefit by having a CLD Survey 2007 SALARY SURVEY RETURN SURVEYS TO: Tak eo ww ON ur sur w.c ath LINE a vey lab dig t est .co m! We encourage your participation in the Cath Lab Digest salary survey! Anyone working in the cath lab can participate. Results will be published in the December 2007 issue of CLD. CathLabDigest@aol.com or via fax at (216) 393-0445. In order for your survey to be included, you MUST answer all questions. 1. Are you a: (check all that apply) ❏ RCIS ❏ RN ❏ RT(R) ❏ Manager/Supervisor ❏ Director ❏ CVT ❏ CCRN ❏ Other: (please specify) 2. Your region: (check all that apply) ❏ Midwest (IA, IL, IN, MI, MO, MS, OH, WI) ❏ Pacific Coast (AK, CA, HI, OR, WA) ❏ New England/Middle Atlantic (CN, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VE, Wash, DC) ❏ Middle South/South (AL, AR, FL, GE, KY, LA, MS, NC, SC, TN, VA, WV) ❏ Central/Southwest (AZ, CO, ID, KS, MT, ND, NE, NM, NV, OK, SD, TX, UT, WY) 3. Years of experience in the cath lab: ❏ “Newbie” (12 mos or less) ❏ Intermediate (1-10 years) ❏ Long-term (10+ years) 4. Is the Registered Cardiovascular Invasive Specialist (RCIS) credential required at your lab? ❏ Yes ❏ Not required, but encouraged ❏ No 5. Do you receive additional financial compensation after obtaining the RCIS credential? ❏ Yes, we receive ❏ No 6. I am paid: Hourly ❏ No 7. Do you get a per-case rate? ❏ Yes, we receive per case 8. In the past year, I received the following increase/bonus: ❏ Annual Wage Increase (%) ❏ Nothing ❏ Retention ❏ Referral ❏ New Hire IF YOU ARE A MANAGER, please supply salary information below for all staff positions at your lab: Salary for: Newbie (12 mos or less) Intermediate (1-10 years) Long-term (10+years) RCIS RN CCRN RT(R) CVT Other (please specify) Reference 1. Pijls N, van Schaardenburgh P, Manoharan G, et al. Percutaneous Intervention of Functionally Nonsignificant Stenosis, 5-Year Follow-Up of the DEFER Study. J Am Coll Cardiol 2007; 49: 2105-2111. http://www.cathlabdigest.com http://www.cathlabdigest.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - November 2007

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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