Progress in Percutaneous Heart Procedures Leads to Update in Clinical Guidelines

Abstract

NOTING RECENT IMPROVEMENTS in devices, techniques, and medications, the cardiology community has updated guidelines for percutaneous coronary intervention (PCI)—just 4 years after publication of previous recommendations. Experts from the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions collaborated on the new guidelines, which were announced November 13 at the American Heart Association’s Scientific Sessions in Dallas (http://www .americanheart.org/presenter.jhtml ?identifier=3035436). PCI is performed about 1 million times annually in the United States. Fueling the 2005 revisions is the rapidly increasing use of drug-eluting stents, said Ted Feldman, MD, a member of the guideline writing committee. Feldman is professor of medicine at Northwestern University Feinberg School of Medicine in Chicago and director of the cardiac catheterization laboratory at Evanston Hospital in Evanston, Ill. He has received research grants and honoraria from drugeluting stent manufacturers. Since the 2001 guidelines were released, the Food and Drug Administration has approved two drug-eluting stents—in 2003, the Cypher sirolimuseluting coronary stent by Cordis Corporation, Miami Lakes, Fla, and in 2004, the Taxus Express paclitaxel-eluting coronary stent system, by Boston Scientific Corporation, Natick, Mass. “Their use in many settings and the data we’ve gathered from clinical trials show their benefit compared with bare-metal stents in a variety of patient subsets,” said Feldman. He added that even though the new devices could achieve superior efficacy and outcomes, the committee could not makeablanket recommendationofdrugeluting over bare-metal stenting for all patients because rigorous studies comparing the two types of stent have yet to be attempted or completed for all conditions. Feldman says that once such research is published, it is likely that drugeluting stents will be recommended for many more patients.