Improvements in percutaneous coronary intervention techniques, stent technology, and adjunctive pharmacotherapy are crucial in myocardial revascularization.
The most commonly used myocardial revascularization procedure is percutaneous coronary intervention (PCI) with stent implantation. Clinicians have focused a great deal of attention on stent-related problems, even though the progression of atherosclerosis of native vessels has just as significant an impact on PCI outcome.
According to an article that reviewed five studies with 5,169 subjects followed up over an average of four years, improvements in PCI techniques, stent technology, and adjunctive pharmacotherapy are crucial. But they should also be accompanied by research focusing on coronary artery disease (CAD) progression and deceleration, stabilization/regression of the atherosclerotic plaque, and optimization of secondary prevention post-PCI.
The review, which was published online ahead of print in Clinical Cardiology, was written by Athanasios Moulias, MD, and Dimitrios Alexopoulos, MD, both of the department of cardiology at Patras University Hospital in Greece.
Despite the proven safety and efficacy of PCI, short- and long-term outcomes are impacted by adverse cardiovascular clinical events that can occur after stent implantation. Events in the first month following PCI are usually attributed to the intervention and considered as periprocedural. Events that occur later, however, arise either from the stented lesion or from disease progression at other sites in the coronary tree.
Significant improvements in stent implantation techniques have been made over the last decade, and the introduction of drug-eluting stents have had a significant impact on the restenosis problem.
“Continuous evolution of stent design, the drug eluted and its delivery systems as well as of the adjunctive antiplatelet pharmacotherapy, have occupied a great part of interventional cardiology literature, reflecting the attention paid to treatment at the stented site. In contrast, improvement of coronary artery disease pharmacological treatment and intensive secondary prevention measures (e.g., risk factors modification) seem to affect the coronary tree as a whole,” the authors wrote.
“CAD often progresses over time despite adequate risk modification and current pharmacological treatment with antiplatelets, β-blocker, angiotensin-converting enzyme inhibitor, and statin. Further research is needed for the possible determination of other potentially modifiable risk factors of CAD progression and development of more
effective therapy post-PCI, possibly with novel agents.”