The year in cardiology 2016: coronary interventions.

Abstract

2016 can be hardly described as a year of revolutions in interventional cardiology. Still multiple randomized studies supported the 3 to 5 year efficacy of metallic drug eluting stents in left main disease, cast doubts on long-term outcome after fully biodegradable stents, discouraged routine thrombectomy during primary PCI, gave a mixed message on the importance of physiological guidance of coronary revascularization, helpful for non-culprit lesions in STEMI, questionable for multivessel disease in allcomers, and defeated the paradigm that a fully arterial surgical revascularization delivers better clinical outcome. ### Revascularization vs. medical therapy We start this review of transcatheter interventions with a trial where bypass surgery rather than stent-assisted angioplasty was used and compared with medical therapy. STICH1 (Surgical Treatment for Ischemic Heart Failure) compared optimal medical therapy (OMT) and surgical revascularization with coronary artery by-pass grafting (CABG) in 1215 patients with left ventricular ejection fraction (LVEF) ≤35%. The negative results at 4.8 years of the original presentation in 2010 (death from any cause in 41% of patients in OMT and 36% in the CABG group, P = 0.12) justified the conservative attitude of our heart failure colleagues towards myocardial revascularization. In 2010–2013, in USA only 17.5% of 67 161 patients hospitalized for new onset heart failure underwent testing for ischemic CAD during the index hospitalization.2 The highlight of the European Society of Cardiology Congress 2016 in Rome was the presentation of the results at 9.8 years of STICHES3 (Surgical Treatment for Ischemic Heart Failure Extension Study), showing progressive divergence of the curves for mortality (66.0% in OMT group vs. 58.9% in the CABG group, P = 0.02) and cardiovascular mortality (49.3% vs. 40.5%, respectively, P = 0.006), with a significant difference in favour of the surgical arm. In the CABG group, the NNT to prevent one death was 14, though mortality was high in both groups. This trial has implications …