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(Circulation. 2002;106:646.)
© 2002 American Heart Association, Inc.

Editorial

Intracoronary Brachytherapy

Time to Sell Short?

David E. Kandzari, MD; Daniel B. Mark, MD, MPH

From the Duke Clinical Research Institute (D.E.K., D.B.M.), Durham, NC.

Correspondence to David E. Kandzari, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail kandz002@onyx.dcri.duke.edu

Key Words: Editorials • brachytherapy • cost-benefit analysis • revascularization • restenosis

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

The introduction of innovative new devices and drugs has been a major influence in the dissemination of catheter-based coronary revascularization procedures into clinical practice. Systematic appraisals of effectiveness have typically come only after regulatory approval and widespread clinical acceptance. Consideration of the potential economic implications of these technologies, if performed at all, has taken place even later. Because percutaneous coronary intervention (PCI) is now not only a central part of modern cardiovascular therapeutics but is also "big business," any significant change in the technology or its use may have an important impact on national healthcare costs and health outcomes. For this reason alone, a more proactive approach utilizing large randomized trials with clinically relevant end points and prospective economic analyses is crucial to allow for an informed debate on new advances.

See p 691

Although early visionaries predicted that percutaneous technology would create a less invasive (and less expensive) alternative to coronary bypass surgery, surgery volume actually increased during the exponential growth period of PCI.¹ Currently, >1 million PCI procedures are performed in the United States each year, with >80% involving the use of a coronary stent.^1,2 For the most part, these are not procedures that have replaced expensive surgeries. Instead, they have "replaced" medical therapy and added billions of dollars each year to the US healthcare budget. Although each major improvement in PCI technology tends to rekindle hopes for a viable percutaneous alternative to bypass surgery, the result has often been to extend the reach of PCI more to . . . [Full Text of this Article]

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