Book Review

Recent Advances in Cardiology

Interventional Cardiovascular Medicine: Principles and Practice

N Engl J Med 1994; 331:1387-1388November 17, 1994

Article

Interventional Cardiovascular Medicine: Principles and Practice
Edited by Gary S. Roubin, Robert M. Califf, William W. O'Neill, Harry R. Phillips III, and Richard S. Stack. 989 pp., illustrated. New York, Churchill Livingstone, 1994. $179.95. ISBN: 0-443-08834-9

Interventional cardiovascular medicine has expanded rapidly during the past 17 years. No longer considered merely the technical counterpart of conventional cardiology, the field has evolved into a discipline that has coronary angioplasty as its primary mission and vascular biology and randomized clinical trials as its scientific foundation.

To accommodate the enormous interest in the field, several new textbooks have been published. Among them, Interventional Cardiovascular Medicine: Principles and Practice has many distinctive features to recommend it. After an authoritative discussion of the biology of the atherosclerotic vessel wall, it presents a patient-oriented approach to interventional cardiovascular treatment. As compared with several other textbooks of interventional cardiology that enumerate all imaginable and some imaginary devices in a manner reminiscent of the Physician's Desk Reference, this book keeps clinical challenges at the center of the discussion. It is difficult for a cohesive theme or philosophy to prevail in a textbook with 69 chapters written by 85 enthusiastic contributors, but the editors successfully emphasize the innovative side of the field. In the name of good patient care, the authors balance their consistent message -- that interventional revascularization procedures can greatly benefit patients with symptomatic coronary artery disease -- with an insightful presentation of clinical decision making and a perceptive interpretation of the results of randomized clinical trials and the analysis of the Duke Databank for Cardiovascular Diseases.

The first printing of a large textbook is likely to contain errors. In this case, the errors are mostly minor, involving small discrepancies between the results discussed in the text and the data presented in tables. Topics that could have been developed further include rates of success with right coronary ostial lesions, thrombolytic intervention for unstable angina and acute myocardial infarction, and interventions for congenital heart disease. More important, there could have been a more thorough presentation of the action, pharmacokinetics, and inhibitors of heparin. Certain sections suffer from repetition. Studies such as the retrospective analysis of the benefits of heparin pretreatment for patients with unstable angina and the study of the success of angioplasty according to lesion complexity are mentioned with numbing regularity. Despite these limitations, this is a very good book. I recommend it for physicians performing interventional cardiovascular procedures or referring patients for such treatment, for trainees in the field, and for researchers in interventional cardiovascular medicine.

John A. Bittl, M.D.
Brigham and Women's Hospital, Boston, MA 02115