New Frontiers in Interventional Cardiology

The latest statistics from the American Heart Association are disturbing: In 2004, an estimated 865 000 Americans will develop a new acute coronary syndrome. Another 700 000 will have a stroke. Unfortunately, the contribution of percutaneous coronary intervention (PCI) to prevent such catastrophic outcomes has been limited. To date, intervention cardiologists have been constrained to the treatment of obstructive atherosclerosis disease in certain regions of the coronary tree. This approach has a clear benefit in reducing ischemia and symptoms but minimal direct impact on patients’ survival. The coming decade in interventional cardiology will be characterized by continued advances and interplay between structural materials and biomaterials, as well as by erosion of the barriers between medical disciplines, including vascular medicine, heart failure and genetics. Advances in imaging technology are on the verge of a clinical debut, which will enhance our screening capabilities to detect subclinical yet hazardous atherosclerosis disease. An expansion of indications for PCI as well as the development and establishment of new therapeutic modalities also are expected in the coming years (Figure 1). Figure 1. Factors promoting (+) or limiting (-) the expansion of interventional cardiology. A comprehensive review of the entire field of intervention cardiology would be impractical. Progress in the areas of drug-eluting stents, detection of vulnerable plaques, percutaneous management of selected patients with stroke and valvular heart disease, angiogenesis and stem cell treatment of congestive heart failure, and increased use of the predictive capacity of genetic markers likely will be pivotal. The goal of this article is to provide an overview of recent achievements in specific areas that may change thinking in the field in the near future (Figure 1). The BENESTENT (BElgian NEtherlands STENT) and STRESS (STent REStenosis Study) trials paved the way for the “stent era” in coronary revascularization.1,2 In-stent restenosis, however, …