Textbook of interventional cardiology

Textbook of interventional cardiology

Asia Pacific Heart J 1999;8(3) Book Review Textbook of Interventional Cardiology, 3rd edition Edited by Eric J. Topol. Philadelphia: W.B. Saunders Co...

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Asia Pacific Heart J 1999;8(3)

Book Review Textbook of Interventional Cardiology, 3rd edition Edited by Eric J. Topol. Philadelphia: W.B. Saunders Company. ISBN 0 7216 7676 6 atherectomy and laser occupy one chapter each, reflecting their maturity to niche indications. The next 3 chapters are devoted to stenting. “The menu” comprehensivelyenablesone to teaseout the similarities and differences among the commercial products available. The chapter on anticoagulation concisely chroniclesthe technical and pharmacologicadvancesthat have enabled the stent to change the landscape of interventional cardiology. The following chapter on indications and limitations gratifyingly addressesthe evidence base for stenting in non-Stress/Benestent lesions.

The publication of the first edition of this text in 1990 heralded the recognition of interventional cardiology as an establishedsubspecialty.Since that time, the field has developedgreatly so that there is now a clearer direction as to its future. This maturity is reflected in the latest edition of this text, widely regarded as the premier referencebook in the area. The first 6 chapters address pharmacologic interventions in acute coronary disease.There is some repetition in severalof thesechapters(the antithrombotic and fibrinolytic chapters, for example) and scant attention to some emerging therapies such as low molecular weight heparins. However, in general, this section is well written, largely up to date, and valuable because it broadens the scope of the text beyond the arenaof pure mechanicalinterventions.

Radiation therapy, a current growth area in interventional cardiology, occupies one chapter, reflecting its novelty at the time of publication. The promise of brachytherapy is recognised by the editor, however, and this chapterprovides a solid introduction to the field now increasinglybuttressedby phaseIII clinical trials. Section 3 of the text is devoted to evaluation of interventional techniques. Percutaneousintracoronary genetransfer, technology approachingclinical practice at a snail’s pace, is dealt with concisely. The chapter on quantitative and qualitative angiography is strong as is the review of intracoronary doppler and pressure monitoring.

Section 2 comprises the bulk of the book, with 30 chapterson key applicationsfor coronary and peripheral interventions.A lesion-specific approachis taken in this sectionconfering an empiric or “this is how I do it” sense to some of the text. This is inevitable in a procedurally baseddiscipline and is valuable for operatorswishing to peruse the relevant chapter prior to embarking on difficult cases. To combat this empiricism, however, there has been an attempt to inject some science, with chapters highlighting an evidence-based approach to generic clinical scenariossuch as multivessel diseaseor acute myocardial infarction. Although the information provided in these chaptersis invaluable, the end result is repetitive at times; for example, some of the information on complex and multivessel treatment is repeatedin the following chapter on randomised trials of myocardial revascularisation.

Section 4 covers recent developments in valvular, congenital and pericardial percutaneousintervention, and Section 5 deals with quality of care, training and credentialling, and medicolegal issues.For the non-U.S. readers, these final chapters provide a sobering perspective of the direction we may expect the interventional field to follow in our countries in years to come.

There follows an excellent series of chapters on the vexing problem of restenosis, from the bench to the bedside. The chapter focussing on clinical issues is particularly informative; the plethora of negative trials is reviewed, with novel insights into the statistical flaws that may account for the dichotomy between promising animal data and disappointingclinical studies.

Topol’s Textbook of Interventional Cardiology is a comprehensive and valuable resource. It should be consulted regularly by interventional cardiologists working in a discipline where practice frequently oversteps the boundaries of the available evidence. Although not without limitations, this latest edition is an improvementon its predecessorsand cementsits position as the premier referencetext in interventionalcardiology.

The following chapter on the approach to the management of the restenotic lesion is insightful; it highlights the dirth of data available to guide therapy in these situations, The remaining chapters in this section are nicely balanced. Directional and rotational

David Brieger Sydney