Optimum guidance of complex PCI by coronary pressure measurement.

Correspondence to: Dr Nico H J Pijls, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands; cardiologie. [email protected] _________________________ I n 1993, 1450 coronary interventions were performed in the Catharina Hospital in Eindhoven, the Netherlands. At that time, due to financial restraints, stents were not available. After two years of follow up, the reintervention rate in that population was 28%. In 1998, stents were available unrestrictedly in the same hospital and 1790 coronary interventions were performed. In that year, stents were implanted in 70% of the procedures and the reintervention rate after two years was 21%. In other words, comparing the pre-stent era with the stent era showed that the reintervention rate in the complete percutaneous coronary intervention (PCI) population in our hospital decreased from 28% to 21%. Thus, the reintervention rate in the stent era had decreased by 25% compared to the pre-stent era. While this decrease in the reintervention rate is not small, it is not that large either. It means that the re-intervention rate today is in the range of 20% if a completely unselected ‘‘true life’’ patient population is considered. And it is beyond doubt that the interventional community has eagerly waited for further developments to decrease this 20% reintervention rate. Recently, we have witnessed the dawn of what might be a new era—the era of drug eluting stents. 2 It will be unrealistic to suppose that the restenosis rate of these new stents will be zero. But if they fulfil only half of their promise, this would be a great step forward and be of major importance for interventional cardiology. Let us suppose that the restenosis rate of these drug eluting stents will be very low indeed, somewhere in the range of 10% at 1–2 years, and that no major unexpected long term side effects will occur. What will be the consequences for the practice of interventional cardiology? Most likely, such a development will result in an extension of the PCI population to include more complex disease. Such a trend is already being observed. Patients with multiple abnormalities in one or more coronary arteries—classical candidates for bypass surgery today— will be more frequently selected for treatment by multivessel coronary intervention; even patients with diffuse disease, with or without superimposed focal lesions, may become candidates for PCI. In these groups of patients in particular, the question arises of how to use the new stents in the best possible way.