The Changing Face of Interventional Cardiology

> Change is the only constant (derived from “all entities move and nothing remains still”).> > —Heraclitus, 401 BCInterventional cardiology began as a discipline after the introduction of coronary balloon angioplasty by Andreas Gruentzig in 1976.1 Technological advances, improved success, and reduced complications led to widespread acceptance of this new procedure, surpassing coronary artery bypass graft (CABG) as the most common means to achieve coronary revascularization. With time, there has been an expansion of the tools used for the coronary angioplasty, and the procedure has been renamed percutaneous coronary intervention (PCI) as a result. Changes in the practice of interventional cardiology over the last 10 years have been more subtle than the first 25 years that were dominated by technological advances, but they are still significant as we gained a better understanding of the best application of PCI. This period has been more about “what we should do” rather than “what we can do.” Expansion of noncoronary interventions including peripheral arterial and structural heart disease interventions has also taken place and probably will dominate the future. Some of the more important changes in practice over the last decade will be discussed with speculation on the future of interventional cardiology.Practitioners are well aware that coronary interventional volume has been decreasing over the last 6 to 8 years. A recent study by Riley et al,2 using the data available from the Centers for Medicare and Medicaid Services from 2001 to 2009, showed that in the United States, diagnostic catheterizations rose from 1 075 623 procedures in 2001 to 1 315 515 in 2004, followed by a steady decline to 1 047 945 in 2009. Similarly, PCI volume rose until 2004 and then fell to 350 134 in 2009. Despite this dip after 2004, there has been an overall average increase of 1.3% per …