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(Circulation. 2008;118:609-611.)
© 2008 American Heart Association, Inc.

Editorial

What Do You Need to Know Before Performing a Percutaneous Coronary Intervention?

Matthew A. Cavender, MD; E. Magnus Ohman, MD

From the Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center.

Correspondence to Magnus Ohman, MD, Duke University Medical Center, 7406 Duke N, Box 3126 DUMC, Durham, NC 27710. E-mail ohman001@mc.duke.edu

Key Words: Editorials • angioplasty • myocardial infarction • registries • risk score

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

The majority of interventional cardiologists spend considerable time reviewing the angiograms before performing a percutaneous coronary intervention (PCI). Over the years, considerable experience has been gained from both clinical observations and investigations that guide the assessment of the risk-to-benefit ratio that leads to the decision of when and how to proceed with coronary revascularization in individual patients. During the early years of balloon angioplasty, the majority of time was spent reviewing the angiogram, because it largely predicted whether the procedure would be successful, but the consistency of such a review among cardiologists was not always present.¹ In that era, angiographic variables by and large predicted outcomes, because abrupt vessel closure and periprocedural myocardial infarction (MI) were relatively common and also predicted later long-term mortality. However, it was also recognized that the nonangiographic variables were more important in predicting the long-term outcomes.² Over time, improved techniques and better understanding of antithrombotic and antiplatelet therapies have reduced both the need for emergent coronary artery bypass grafting (CABG) and the mortality rate despite the increased use of PCI in high-risk populations.³ Given the technical successes in interventional cardiology, focus has now moved from the feasibility of PCI to the optimal use of existing techniques to improve survival and reduce symptomatic heart disease.

Article p 632

In order to optimize care, the interventional cardiologist needs to be able to predict the outcomes, including long-term mortality, so that he or she can best define the risks and benefits of PCI for the patient. Multivariable analyses . . . [Full Text of this Article]

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