The Changing Face of Interventional Cardiology

Abstract

Change is the only constant (derived from "all entities move and nothing remains still").-Heraclitus, 401 BC I nterventional cardiology began as a discipline after the introduction of coronary balloon angioplasty by Andreas Gruentzig in 1976. 1 Technological advances, improved success, and reduced complications led to widespread acceptance of this new procedure, surpassing coronary artery bypass graft (CABG) as the most common means to achieve coronary revascularization. With time, there has been an expansion of the tools used for the coronary angioplasty, and the procedure has been renamed percutaneous coronary intervention (PCI) as a result. Changes in the practice of interventional cardiology over the last 10 years have been more subtle than the first 25 years that were dominated by technological advances, but they are still significant as we gained a better understanding of the best application of PCI. This period has been more about "what we should do" rather than "what we can do." Expansion of noncoronary interventions including peripheral arterial and structural heart disease interventions has also taken place and probably will dominate the future. Some of the more important changes in practice over the last decade will be discussed with speculation on the future of interventional cardiology.Practitioners are well aware that coronary interventional volume has been decreasing over the last 6 to 8 years. A recent study by Riley et al, 2 using the data available from the Centers for The cause of the decline in cardiac catheterization volume is multifactorial. The factors that have contributed include a decrease in the prevalence of coronary disease due to improved primary prevention and improvement in medical therapy and secondary prevention for those with established disease. The reduction in disease prevalence is demonstrated by the reduction in death due to cardiovascular disease (CVD) by 30% since it peak in 1980. 6 However, we have a long way to go to truly preventing CVD, as ideal control of the 7 key risk factors was only 0.1% in a study of healthy people in the United States. 7 Rates of poorly controlled CVD risk factors for patients with known disease are also unacceptably high. 8 The current decline in CVD may be shortlived if the current increase in obesity by 8% to 15% and type 2 diabetes by 60% over the last 10 years persists. 6 The aging of the population probably will be the most important factor for the increase in CVD in the future, with coronary heart disease expected to increase by 7.5% in the next decade and by 16% over the next 20 years. 9 A decline in overall revascularization volume has also contributed to the fall in cardiac catheterization procedure rates, but the fall has been greater for CABG than for PCI. The declines in surgery have been largely attributed to a shift to the use of PCI in the majority of patients needing revascularization. Currently, only patients with the most complex CAD are referred for CABG. The smaller fall in PCI volume than with CABG is also due to an in...

Cost-effectiveness of transcatheter versus surgical management of structural heart disease

“…1 The field of structural interventional cardiology was first developed with transcatheter valvuloplasty of the mitral valve followed by the introduction of closure devices of atrial septal defects (ASD) and patent foramen ovale (PFO). Importantly, the recent introduction of transcatheter aortic valve replacement (TAVR) and the development of new transcatheter techniques to manage mitral regurgitation promises an expected growth of 30% in the volume of structural procedure over the next decade.…”

Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease

“…Advances in technology, use of bare metal stents and atherectomy, and intravascular imaging have helped to increase success and reduce complications. It is estimated by industry that peripheral interventions will grow an average of 8% per year over the next 4 years [3,4]. …”

Interventional Cardiology

“…The field of interventional cardiology is now much broader and more complex than ever before and specialization within interventional cardiology is increasing. 4 This review will discuss 2 areas where change has been most dramatic: coronary and valvular interventions.…”