[Future of interventional cardiology in the treatment of coronary artery disease].
BACKGROUND
The development of interventional cardiology (PCI) started already with the introduction of catheterization but was pushed forward by A. Grüntzig with the percutaneous transluminal coronary angioplasty (PTCA) 1977. In the beginning very slow progress could be observed. This changed when Grüntzig changes to Emory university, Atlanta. Already after 10 years alternative techniques were introduced like stent implantation and rotablation, coronary atherectomy, laser angioplasty, ultrasound therapy. During the following years, it became obvious that only for stent implantation (see W. Rutsch et al, Berlin, p.481) and rotablation (see T. Dill et al, Bad Nauheim, p.502) standard indications could be seen in addition to PTCA. Brachytherapy for treatment of in stent restenosis and laserwire recanalisation of occluded vessels were added.


METHODS
New protection systems - aspiration or filters - were introduced for increase of PCI safety in venous bypass stenosis (see C. Hamm et al, Bad Nauheim, p.527). The main step forward seems to be the introduction of drug eluting covered stent either with polymer (see E. Grube et al, Siegburg, p.508) or ceramic coating (see H. Wieneke et al, Essen, p.518). Restenosis rates, which were already reduced by bare stent for 20-30%, could be lowered below 10%.


RESULTS
In patients with diabetes and main stem stenosis or multi vessel disease, coronary artery bypass surgery is indicated, but in other patients PCI seems to be as good as surgery in relation to mortality and myocardial infarction rates. With drug eluting stents the role of PCI may become even more pronounced, because the revascularization rate could be further reduced (see W. Rutsch, Berlin, p.481).


CONCLUSIONS
The future will demonstrate even further main steps for interventions like the percutaneous bypass attempts and the introduction of gen-therapy (A. B. Buchwald, Göttingen, p.533). Meanwhile we can observe a drop of 1-2% mortality in coronary artery disease related to 60% influence of prevention and 40% to advanced PCI therapy. This is still a remarkable successful story in medicine provided by cardiology.
Erbel
Raimund
R
Klinik für Kardiologie, Medizinische Klinik und Poliklinik, Universitätsklinikum, Essen, Germany. erbel@med.uni-essen.de
Konorza
Thomas
T
Haude
Michael
M
Dagres
Nikolas
N
Baumgart
Dietrich
D
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000639:trends*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000639:trends*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005544:Forecasting; D005858:Germany; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000639:trends*; D015607:Stents / Q000639:trends*; D015996:Survival Rate