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(Circulation. 2002;106:1592.)
© 2002 American Heart Association, Inc.

Editorial

A Decade of Improvement in the Clinical Outcomes of Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease

Jeffrey J. Popma, MD; Richard E. Kuntz, MD, MSc; Donald S. Baim, MD

From the Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Donald S. Baim, MD, Center for Integrating Medicine and Innovative Technology (CIMIT), Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail dbaim@partners.org

Key Words: Editorials • coronary disease • revascularization • vessels • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Twenty-five years after its tentative beginnings, percutaneous coronary intervention (PCI) has become the dominant form of coronary revascularization. This year, the 800 000 PCI procedures are more than double the number of coronary artery bypass graft (CABG) surgeries. Although there had already been substantial growth throughout the 1980s and early 1990s as a result of improving equipment and techniques for conventional balloon angioplasty, the accelerated growth since 1994 has clearly been fueled by the rapid adoption of coronary stenting. Today, >80% of PCI procedures involve stent placement, supported by a series of randomized trials that have demonstrated better acute angiographic results, reduced emergency surgery, and reduced recurrence rates (restenosis) when stents are placed properly with an effective antiplatelet regimen. In practice, however, the excellent results in the circumscribed lesion types studied in the key randomized trials have been generalized to other lesion morphologies (eg, small vessel, diffuse disease, bifurcation lesions) for which the evidence supporting stent use is less clear. Over the past several years, there has been a concurrent increase in the use of platelet glycoprotein IIb/IIIa inhibitors as an adjunctive therapy during PCI. A plethora of randomized clinical trials demonstrate that these agents are very effective in reducing periprocedural myocardial infarction, defined as elevation of cardiac enzymes.^1–3

See p 1627

Taken together, these 2 advances have made PCI faster, safer, and more durable than in the pre-1990 era in which Plain Old Balloon Angioplasty (POBA) was the only form of PCI available. Emergency bypass surgery to treat an . . . [Full Text of this Article]

Related Article:

Contemporary Percutaneous Coronary Intervention Versus Balloon Angioplasty for Multivessel Coronary Artery Disease: A Comparison of the National Heart, Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) Study

V.S. Srinivas, Maria Mori Brooks, Katherine M. Detre, Spencer B. King, III, Alice K. Jacobs, Janet Johnston, and David O. Williams
Circulation 2002 106: 1627-1633. [Abstract] [Full Text]

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