Lessons learned from 40 years of PCI

It took Roentgen to develop x-ray in the 19th century, Forssmann to perform the first cardiac catheterization on himself in 1929, Sones, Amplatz, and Judkins to develop coronary angiography after 1958, and Dotter to introduce catheter-based therapy in 1964 to let Gruentzig succeed with the first percutaneous coronary intervention (PCI) on September 16, 1977. After a rather slow start due to skepticism and the fact that coronary angiography was only performed after long periods of angina proved refractory to drugs (typically revealing triple vessel disease), PCI grew to be the most common intervention in cardiology and perhaps in medicine in general. The sustainability of PCI cannot be better documented than with the world’s first patient still enjoying an excellent long-term result after 40 years.Refining balloon, guidewire, and guiding catheter, the 3 key assets of PCI, and adding the stent (introduced in 1986 by Puel) is most noteworthy since the first PCI case. The current drug eluting stents (DES) are easy to implant and safe. They provide excellent long-term results that are hard to challenge. Replacing them by bioabsorbable vascular scaffolds (BVS, first used in Japan) is intriguing considering that the stent’s beneficial contribution ends after a couple of weeks. Yet, it is unlikely that BVS will ever be truly competitive with DES.The future will see slow but continued growth in numbers as coronary artery disease (CAD) will be detected ever more early and universally. Due to improved prevention the average age of the population will increase and age limits for PCI will be further raised. Consequently, the ratio PCI / coronary artery bypass grafting (CABG) will further increase. Notwithstanding, CABG will remain superior for advanced CAD.