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INTERVENTIONAL CARDIOLOGY IN 2018

Advancing the evidence base in interventional cardiology

Nature Reviews Cardiology volume 16, pages 79–81 (2019)Cite this article

Subjects

The main advances in interventional cardiology in 2018 include the new European guidelines on revascularization, new developments in the treatment of cardiogenic shock, novel stent technology from Asia and clinical trial data showing no benefit of dropping aspirin after stenting.

Key advances

  • The 2018 ESC guidelines on myocardial revascularization provide the most up-to-date, evidence-based consensus recommendations1.

  • For patients presenting with ST-segment elevation myocardial infarction, multivessel disease and cardiogenic shock, we now know that the acute intervention should be to treat the culprit vessel only2.

  • New stent technologies with thin struts, absorbable polymers and reduced drug doses are proving to be equivalent to current technology in the first year after implantation and might show benefits with longer follow-up3.

  • The first absorbable scaffolds have not met clinical expectations and have been removed from the market4.

  • Ticagrelor monotherapy after stent implantation did not show a benefit at 2 years compared with standard dual antiplatelet therapy5.

Several advances in interventional cardiology have occurred during 2018. The new ESC guidelines on myocardial revascularization provide the most up-to-date, evidence-based recommendations on coronary intervention with stents and surgery1. The strategy of culprit-vessel-only revascularization of patients presenting with cardiogenic shock showed good 12-month outcomes2, with questions about bystander-vessel revascularization again being asked. New stent technology from Asia provides noninferior results to those with established stents3. The final randomized trial results for the absorbable scaffolds confirm good clinical results but increased rates of stent thrombosis compared with conventional stents, and did not show the much-hoped reduction in angina4. Finally, dropping aspirin after stenting does not provide a benefit in reducing the risk of bleeding5.

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References

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Authors and Affiliations

  1. Queen Mary University of London and the Barts Heart Centre, West Smithfield, London, UK

    Andreas Baumbach

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  1. Andreas Baumbach
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Correspondence to Andreas Baumbach.

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Competing interests

A.B. has received consulting fees from Abbott Vascular, Cardinal Health and Microport, and speaker fees from Astra Zeneca.

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Baumbach, A. Advancing the evidence base in interventional cardiology. Nat Rev Cardiol 16, 79–81 (2019). https://doi.org/10.1038/s41569-018-0142-5

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