The Year in Cardiology 2012: coronary intervention

Abstract

I am delighted to provide readers of the European Heart Journal with an overview of scientific data relating to Coronary Intervention in 2012. This article aims to summarize the important publications and presentations; it includes a summary of the main interventional meetings (ACC, EuroPCR, ESC, TCT, and AHA) together with a selection of important publications from the major general and specialist journals. Throughout Europe there has been a move towards percutaneous coronary intervention (PCI) being performed in units without on-site cardiac surgery. In the UK, over 60% of units do not have on-site surgery and these units generally perform a lower volume of PCI than those with on-site surgery (median of 435 compared with 1454 procedures, respectively). The need for emergency surgery is now a very uncommon complication. The Atlantic CPORT Investigators randomized, in a non-inferiority design, nearly 19 000 patients undergoing PCI to a hospital with or without on-site surgery in a ratio of 1–3. Six-week mortality was virtually identical (1.0 vs. 0.9%) and 9-month major adverse cardiac events (MACE) were also similar (11.2 vs. 12.1%); however, target vessel revascularization (TVR) was higher without on-site surgery (6.5 vs. 5.4%, P = 0.01). This difference was seen regardless of the definition of TVR and regardless of stent type and may reflect a more conservative approach or a lower initial success rate without on-site surgery. In the USA, a very small proportion of total PCI was performed without on-site surgery and it remains to be seen whether this study will alter that proportion.1 Public reporting of patient outcomes following PCI is an important tool to monitor the quality of care; however, it may lead some operators to become ‘risk-averse’. Joynt et al . reported a retrospective observational study of patients admitted with an acute coronary syndrome to US hospitals in …