State of the art in coronary intervention

Issues related to restenosis have been known since the beginning of coronary intervention, and by now, restenosis has been characterized in terms of its time course, pathophysiology, clinical presentation, and some of its histology. In 1984, the initial National Heart, Lung, and Blood Institute's percutaneous transluminal coronary angioplasty registry reported a restenosis rate of 33.6% and identified male gender, new unstable angina, diabetes mellitus, and treatment of bypass graft stenoses as risk factors. Today restenosis still occurs in 33% of patients, is still associated with recurrent angina, and occurs usually within several months after a successful intervention. These current conclusions are very interesting because we now treat a clearly different patient population. Clinical trials have documented that restenosis results in adverse clinical consequences. In recent large clinical trials involving patients with class B or C lesions, pharmacologic intervention with such agents as tranilast was still associated with a 33% restenosis rate and had no significant effect on major adverse cardiac events. More recently, drug-coated stents have been introduced and are undergoing testing in large clinical trials to definitively establish the long-term efficacy and safety suggested in their early promising experience. Thus, whether the solution for restenosis is at hand or whether we will continue to see patients who undergo successful intervention and develop restenosis only months later in the same position as the initial lesion remains an open issue.