New devices for percutaneous coronary intervention are rapidly making bypass surgery obsolete.
OBJECTIVE
This review summarizes recent and cumulative progress in the success, safety, applicability, and durability of percutaneous coronary intervention.


RESULTS
Improvements in basic percutaneous coronary intervention (PCI) equipment and the availability of bare metal stents in the mid-1990s improved acute procedural success to 98%, reduced the emergency surgery rate to 0.2%, and reduced the incidence of recurrent symptoms due to restenosis at the treated site to 15 to 20%. The recent availability of drug-eluting stents has reduced the in-stent neointimal proliferation that causes restenosis and reduced the incidence of symptomatic recurrence to less than 5%, rivaling that of bypass surgery. The work on better antithrombotic pharmacology, distal embolic protection, and devices for crossing chronic total occlusions will further add to the armamentarium for catheter-based revascularization.


CONCLUSIONS
Based on progress over the past decade, PCI has grown to represent about two-thirds of all coronary revascularization (800,000 PCI vs 350,000 bypass surgeries). Recent and ongoing progress will make bypass surgery largely obsolete within the next several years.
Baim
Donald S
DS
Department of Medicine, Harvard Medical School, Center for Integration of Medicine and Innovative Technology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. dbaim@partners.org
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D021721:Balloon Occlusion / Q000295:instrumentation / Q000592:standards; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000592:standards; D003327:Coronary Disease / Q000628:therapy*; D004864:Equipment and Supplies / Q000592:standards; D006801:Humans