Controversies in interventional cardiology: eminence, common sense, and evidence.

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] Interventional Cardiology has revolutionized cardiovascular medicine over the last three decades. Starting with a simple balloon1 and later bare-metal and drug-eluting stents and scaffolds2 ( Figure 1 ), numerous new devices including occluders for patent foramen ovale3 and atrial as well as ventricular septal defects, and recently for catheter-based valve implantation,4,5 have been developed and also partly tested in first-in-men studies and randomized trials. In his ESC Lecture ‘ Interventional cardiology, where real life and science do not necessarily meet ’, Bernhard Meier from the University Hospital Bern in Switzerland challenges the concept that evidence-based diagnosis, decision-making, and therapy is and should primarily guide the field.6 He notes that generating and publishing evidence is a tedious job according to ever new and tightened research practice regulations.7 Rules will never prevent the typical human behaviour to show new things as being shinier and old things as being dustier than they really are. He continues by discussing examples of misguidance by poorly produced or misinterpreted evidence. Coronary stents, for instance, were first underestimated due to the fact that they were generally used in bailout situations2 where the outcome remained rather dismal. Then they were overused rather to the detriment of the patient. Now with drug-eluting stents, the overuse persists, but, due to the lower rate of restenosis8 and stent thrombosis,9 is no longer a concern. However, the enhanced potential of drug-eluting stents compared with bare-metal stents was poorly exploited for >10 years because of reports that slipped through the net of good review and publication practice to convey the untenable message that bare-metal stents were preferable.10 Further, Meier believes that the use of fractional flow reserve for decision-making1 … [1]: /embed/inline-graphic-1.gif