From "simplicity" to "complexity" and back again?

There is a question that is hard to leave behind in this month’s CLD interview with TENACITY trial PI Dr. David Moliterno: How much complexity do you realistically think the ACS-primary PCI process can stand? The question (courtesy of CLD board member Jackson Thatcher, MD) queries the results of tight time constraints and potentially complex medication combinations on real-life patient care. Like so many things in life, success may arise from two primary things: personalities and infrastructure. How informed, organized and proactive is each individual involved with these patients’ treatment processes? Similarly, how informed, organized, and proactive are the institutions where these patients receive care? One can compensate for the other, but clearly patient care will be safer, of higher quality, and more quickly delivered when both work in concert. When you think back to five years ago, or ten do things appear much simpler in terms of patient care? Who knows where we’ll be five or ten years from now… Perhaps thinking, with a chuckle, how easy/tough things were, then turning to a patient and injecting vascular endothelial growth factor to repair ischemic myocardium (diagnosed after an MRA or CT scan, of course). It’s an exciting thought. This month, Cath Lab Digest offers both a look ahead and a look back. Marc Streem shares his facility’s review of diagnostic cath procedures performed in 2003, seeking to uncover any relationship between complications and arterial puncture closure devices (APCDs) in 740 patients. Marcie Gruchevsky, RN, of Florida Cath Lab in Orlando, relates her lab’s positive experience with Vascular Solutions’ D-Stat Dry hemostasis pad in 110 patients. Looking back on a full career, CLD board member Jason Money, RN, RCIS, reflects on the lessons he’s learned as a traveling professional and notes of his very first impression of the cath lab, I felt [they] were the coolest guys around. Who can argue with that? As CLD looks to the future, you’ll find Dr. Jacques Seguin’s thoughts on percutaneous aortic valve repair, a 2005 coding update focusing on intravascular ultrasound and fractional flow reserve, and an explanation of why the recently begun TENACITY trial may one day change the way GP IIb/IIIa inhibitors, heparin and bivalirudin are utilized. Knowledge is the one thing no one can ever take from you. Rebecca Kapur Managing Editor CathLabDigest@aol.com

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