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Interventional cardiology has just celebrated its 30th anniversary. Since its inception in 1977, when Andrea Greuntzig performed his first angioplasty in Zurich, the field has seen continuous and at times exponential growth. However, these advances were challenged by the negative results of few well designed randomised clinical trials in 2006–2007 (OAT trial, BASKETLATE trial, SCAAR trial, COURAGE trial, etc.). The results of some of these trials were expected, while others made us critically analyse the optimal mode of treatment in certain subsets of coronary artery disease (CAD) patients.

Therefore, after an approximate 15% decrease in the number of percutaneous coronary intervention (PCI) procedures in the US in 2007, 2008 has started on a positive note of greater understanding of various issues and a wish to once again expand and develop the field of interventional cardiology. The issue of late thrombosis with drug-eluting stents (DES) seems to have been resolved with the presentation of long-term data by the same investigators (SCAAR Investigators) who first brought the problem to light at the European Society of Cardiology (ESC) meeting in 2006. This shift is largely the result of an emphasis on clopidogrel compliance and extending the duration of therapy from the traditional one year to two to three years or beyond. There are now data from four large registries in favour of DES against bare-metal stents (BMS) in terms of lower mortality at two to three years. The role of DES versus coronary artery bypass graft (CABG) in multivessel diabetes (CARDia trial) and multivessel plus left main disease (SYNTAX trial) was further clarified at the ECS 2008 meeting, with equivalency in terms of the hard end-points of death, myocardial infarction (MI) and stroke (lower stroke rates with PCI in both trials) but higher repeat revascularisation for DES compared with CABG.

In addition, interventionalists are increasingly involved in non-coronary procedures such as endovascular interventions (renal, carotid, peripheral vessels) and atrial septal defect (ASD)/patent foramen ovale (PFO) closures. The overall outcomes of these non-coronary procedures when performed by interventional cardiologists have been extremely satisfactory, which again can be attributed to technical advances and peer-reviewed publications.

One important area of new development and growth in interventional cardiology is percutaneous aortic valve replacement, with two devices (Edwards-Sapien and CoreValve) already approved for clinical use outside the US. These two devices are still undergoing randomised trials in the US – the PARTNER trial for the Edward valve is ongoing, while the CoreValve trial is under US Food and Drug Administration (FDA) review.

Bleeding complications have taken centre stage in the short- and long-term success and outcomes of PCI, surpassing even re-infarction as the major co-morbidity and mortality predictor after PCI and acute coronary syndromes. This has resulted in increasing use of bivalirudin, a potent antithrombin that has consistently shown lower bleeding rates compared with traditional heparin and glycoprotein (GP) IIb/IIIa inhibitors. Therefore, it is of vital importance that we continue to analyse our outcomes in order to guide our peers as to the appropriate indications for PCI in the treatment of CAD patients. This can be achieved through scientific publications, review articles presenting a balanced perspective and performance of live interventional procedures.

I can assure you that the topics covered in the 2008 issue of Interventional Cardiology will focus on many of these topical issues.