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The future of interventional cardiology
JICC-299; No. of Pages 3 journal of indian college of cardiology xxx (2015) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jicc
Short Communication
The future of interventional cardiology Tyrone Collins * 1516 Jefferson Highway, New Orleans, LA 70121, United States
article info Article history: Received 25 August 2015 Accepted 30 October 2015 Available online xxx
Interventional cardiology began after Dr. Andreas Gruentzig introduced balloon angioplasty in 1976. Percutaneous transluminal angioplasty has evolved and has been replaced by the term percutaneous coronary intervention (PCI).
The initial 25 years were dominated by many technological advances but now the emphasis is more focused on what should be done as opposed to what can we do. There is a trend for declining numbers of coronary interventional procedures (Fig. 1). This may be the result
Fig. 1 – Trend of coronary interventional procedures. * Tel.: +1 504 842 3786. E-mail address: [email protected] http://dx.doi.org/10.1016/j.jicc.2015.10.029 1561-8811/# 2016 Published by Elsevier B.V. on behalf of Indian College of Cardiology.
Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
JICC-299; No. of Pages 3
2
journal of indian college of cardiology xxx (2015) xxx–xxx
Fig. 2 – Multifactorial etiology of decline in catheterization volume.
of better medical therapy in part and the reluctance of some physicians to refer patients for invasive procedures. It is important to note that the numbers of coronary artery bypass graft (CABG) procedures and PCI have both declined. The decline in CABG is not explained by the PCI procedures. Catheterization volumes have declined due to a multitude of factors including decrease in disease prevalence, concerns
about stent thrombosis, prolonged antiplatelet therapy, unnecessary stenting, decreased reimbursement, risk of malpractice, and increasing complexity of patients (Fig. 2). Despite the decline in coronary procedures, there has been an increase in the number of noncoronary interventions. These noncoronary procedures that include mitral and aortic valve procedures will increase in the future as the population ages. The practice of interventional cardiology will be different in the future. Coronary intervention will remain the dominant procedure and should increase with the aging Peripheral interventions will similarly population. increase. The greatest growth will be in the valvular interventions. Future technologies will require the interventionalist to acquire new skills and training (Fig. 3A–C). Operator techniques must improve. Training programs will need to adapt to the changes. There is a need for accelerated device development, better understanding of science, and improved pharmacology. Durable and less invasive therapies are needed. We have to monitor and improve outcomes. Practice models will change in the future. The supply and demand for interventionalist remains to be defined but the future of interventional cardiology remains stable.
Fig. 3 – Future technologies. (A) Robotic assisted PCI. (B) Bioabsorbable stents. (C) Nanotechnology. Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
JICC-299; No. of Pages 3 journal of indian college of cardiology xxx (2015) xxx–xxx
Conflicts of interest The author has none to declare.
2. Naidu SS. Thoughts on the future of interventional cardiology workforce. J Invasive Cardiol. 2013;25(3). 3. Faxon DP, Williams DO. The changing face of interventional cardiology. Circ Cardiovasc Interv. 2012;5:325–327.
suggested reading
1. New frontiers in interventional cardiology: from the past to the future. Hellenic J Cardiol. 2014;55:87–88.
Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jicc
Short Communication
The future of interventional cardiology Tyrone Collins * 1516 Jefferson Highway, New Orleans, LA 70121, United States
article info Article history: Received 25 August 2015 Accepted 30 October 2015 Available online xxx
Interventional cardiology began after Dr. Andreas Gruentzig introduced balloon angioplasty in 1976. Percutaneous transluminal angioplasty has evolved and has been replaced by the term percutaneous coronary intervention (PCI).
The initial 25 years were dominated by many technological advances but now the emphasis is more focused on what should be done as opposed to what can we do. There is a trend for declining numbers of coronary interventional procedures (Fig. 1). This may be the result
Fig. 1 – Trend of coronary interventional procedures. * Tel.: +1 504 842 3786. E-mail address: [email protected] http://dx.doi.org/10.1016/j.jicc.2015.10.029 1561-8811/# 2016 Published by Elsevier B.V. on behalf of Indian College of Cardiology.
Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
JICC-299; No. of Pages 3
2
journal of indian college of cardiology xxx (2015) xxx–xxx
Fig. 2 – Multifactorial etiology of decline in catheterization volume.
of better medical therapy in part and the reluctance of some physicians to refer patients for invasive procedures. It is important to note that the numbers of coronary artery bypass graft (CABG) procedures and PCI have both declined. The decline in CABG is not explained by the PCI procedures. Catheterization volumes have declined due to a multitude of factors including decrease in disease prevalence, concerns
about stent thrombosis, prolonged antiplatelet therapy, unnecessary stenting, decreased reimbursement, risk of malpractice, and increasing complexity of patients (Fig. 2). Despite the decline in coronary procedures, there has been an increase in the number of noncoronary interventions. These noncoronary procedures that include mitral and aortic valve procedures will increase in the future as the population ages. The practice of interventional cardiology will be different in the future. Coronary intervention will remain the dominant procedure and should increase with the aging Peripheral interventions will similarly population. increase. The greatest growth will be in the valvular interventions. Future technologies will require the interventionalist to acquire new skills and training (Fig. 3A–C). Operator techniques must improve. Training programs will need to adapt to the changes. There is a need for accelerated device development, better understanding of science, and improved pharmacology. Durable and less invasive therapies are needed. We have to monitor and improve outcomes. Practice models will change in the future. The supply and demand for interventionalist remains to be defined but the future of interventional cardiology remains stable.
Fig. 3 – Future technologies. (A) Robotic assisted PCI. (B) Bioabsorbable stents. (C) Nanotechnology. Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
JICC-299; No. of Pages 3 journal of indian college of cardiology xxx (2015) xxx–xxx
Conflicts of interest The author has none to declare.
2. Naidu SS. Thoughts on the future of interventional cardiology workforce. J Invasive Cardiol. 2013;25(3). 3. Faxon DP, Williams DO. The changing face of interventional cardiology. Circ Cardiovasc Interv. 2012;5:325–327.
suggested reading
1. New frontiers in interventional cardiology: from the past to the future. Hellenic J Cardiol. 2014;55:87–88.
Please cite this article in press as: Collins T. The future of interventional Q1cardiology, J Indian Coll Cardiol. (2016), http://dx.doi.org/10.1016/j. jicc.2015.10.029
3