Controversies in interventional cardiology: eminence, common sense, and evidence

Thomas F. Lüscher
2016 European Heart Journal  
Interventional Cardiology has revolutionized cardiovascular medicine over the last three decades. Starting with a simple balloon 1 and later bare-metal and drug-eluting stents and scaffolds 2 (Figure 1) , numerous new devices including occluders for patent foramen ovale 3 and atrial as well as ventricular septal defects, and recently for catheter-based valve implantation, 4,5 have been developed and also partly tested in first-in-men studies and randomized trials. In his ESC Lecture
more » ... Lecture 'Interventional cardiology, where real life and science do not necessarily meet', Bernhard Meier from the University Hospital Bern in Switzerland challenges the concept that evidence-based diagnosis, decision-making, and therapy is and should primarily guide the field. 6 He notes that generating and publishing evidence is a tedious job according to ever new and tightened research practice regulations. 7 Rules will never prevent the typical human behaviour to show new things as being shinier and old things as being dustier than they really are. He continues by discussing examples of misguidance by poorly produced or misinterpreted evidence. Coronary stents, for instance, were first underestimated due to the fact that they were generally used in bailout situations 2 where the outcome remained rather dismal. Then they were overused rather to the detriment of the patient. Now with drug-eluting stents, the overuse persists, but, due to the lower rate of restenosis 8 and stent thrombosis, 9 is no longer a concern. However, the enhanced potential of drug-eluting stents compared with bare-metal stents was poorly exploited for .10 years because of reports that slipped through
doi:10.1093/eurheartj/ehw293 pmid:27401220 fatcat:pfc4vobkxvgk7oe4s6g4d7vd5u