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In the field of interventional cardiology, 2007 will be remembered as a year of disagreement concerning the safety and efficacy of transcatheter cardiovascular interventions. The safety concerns that have arisen regarding drug-eluting stent (DES) thrombosis and the lack of clinical benefit of percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) – as suggested by the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial – have been amplified and distorted by the media, with negative repercussions for the perception of interventional cardiology among both patients and physicians.

In response, the interventional cardiology community has continued to seriously and scientifically debate the safety and efficacy issues surrounding transcatheter cardiovascular interventions, and has scaled down the harmful messages produced by the initial meta-analysis of randomised trials of DES through more complete and refined analyses. In addition, it must be stressed that the demonstration of non-improvement in survival after coronary revascularisation in patients with stable CAD associated with low-risk coronary anatomy can be considered as expected and nothing new.

In the short term, well-designed studies will clarify the efficacy of DES in off-label indications such as diffuse or high-risk CAD. It is highly likely that new-generation DES will improve the safety and efficacy profile of these devices by increasing biocompatibility, inhibiting proliferative responses and promoting quick endothelial healing.

The primary role of PCI in acute coronary syndromes is not in question. However, further advances in techniques and adjunctive therapies in the setting of acute coronary syndromes are expected, with the goal of more effective reperfusion at myocardial level in acute myocardial infarction, fewer procedural complications such as embolisation or bleeding and early recognition of vulnerable coronary plaques. At the same time, the results of preliminary studies suggest tremendous advances in the endoluminal treatment of peripheral vascular disease and structural heart disease, including intracranial vessel and congenital and acquired valvular diseases. It is easy to predict that the attempts to resolve the issues discovered so far will be largely successful, and that new techniques and devices – including adjunct pharmacological therapies – will become available in the coming years, with the aim of overcoming the current limitations of interventional cardiology.

Interventional cardiology is today being challenged by controversial or equivocal studies. A critical appraisal of the current debate and the results of new studies will allow us to resolve this situation. I therefore hope you find Interventional Cardiology 2007 a most valuable and informative read.