It is only 26 years since the first percutaneous transluminal coronary angioplasty (PTCA) was carried out by the pioneering Swiss radiologist, Andreas Greuntzig, heralding the dawn of interventional cardiology. In this short time, interventional cardiology has overcome many limitations and undergone major evolutionary changes—most notably the development of the coronary stent. Worldwide, many thousands of patients now safely undergo percutaneous coronary intervention every day, and the numbers continue to grow. In many countries, the numbers are similar to, or exceed, bypass surgical procedures. Although, at first, PTCA was indicated only as treatment for chronic stable angina caused by a discrete lesion in a single vessel, this has now progressed to encompass multi-lesion and multi-vessel disease. Moreover, percutaneous intervention is now becoming widely used in the management of unstable angina and acute myocardial infarction with definite benefits in terms of morbidity and mortality. The effectiveness and safety of these procedures has undoubtedly been enhanced by the adjunctive use of new anti-platelet and antithrombotic agents. As the indications increase and more patients are treated, so inevitably do the demands on healthcare budgets. Undoubtedly, percutaneous intervention is expensive. However, this burden must be weighed against bypass surgery, which is even more costly, and multi-drug treatment—which would be required over many years. Although percutaneous coronary intervention has held centre stage in cardiology, major in-roads have also been made in noncoronary areas.
Transcatheter valvuloplasty, ethanol septal ablation and closure devices have become effective and safe alternatives to surgery, as have paediatric interventional procedures. A greater understanding of cardiac electrophysiology has led to important advances in the treatment of arrhythmias, and implantable cardioverter defibrillators are benefiting ever larger numbers of patients. Where are we heading? This is perhaps the biggest question in the minds of many interventional cardiologists. New technology generated by industry and new techniques coupled with high levels of expertise are fuelling advances in almost all areas of interventional cardiology. As drug-eluting stents address the Achilles’ heel of angioplasty and stenting—restenosis—the huge increase in percutaneous coronary procedures seen over recent years is likely to increase even further, and will probably be double the rate of bypass surgery within a decade. In writing and editing this book, I have endeavoured to present broad (and sometimes complex) aspects of interventional cardiology in a clear, concise and balanced manner. To this end, an easy-to-read style of text, avoiding jargon and exhaustive detail, has been used supplemented with many images and graphics.