Percutaneous coronary intervention: recommendations for good practice and training.

Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society. Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33,652 to 62,780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field. It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative.

[Elective coronary angioplasty in the unprotected branch of the left coronary artery]. / Elektivní koronární angioplastika nechráneného kmene levé vencité tepny.

BACKGROUND: PTCA of the left main stem is an alternative therapy to coronary artery bypass grafting for left main stenosis. METHODS AND RESULTS: For the retrospective analysis, 32 consecutive patients referred for left main PTCA were selected. Patients were subdivided into 2 groups. Group I consisted of 17 patients with no concomitant disease and with good left ventricular function, where CABG was an alternative strategy. 15 patients of the group II were patients to whom bypass was contraindicated for cardiac or extracardiac reasons (malignancy, poor LV function, non graftable) and they were recommended for the palliative treatment of their angina symptoms. We observed 100% procedural success rate of the PTCA in both groups. There was no mortality at 6-month follow up among patients of the group I and 13% clinical restenosis rate at 6 months. In patients of the group II there was total 6-month mortality 26.6%, all due to causes unrelated to procedure or coronary ischaemia (progression of malignancy, intractable heart failure). CONCLUSIONS: PTCA to left main stem represents an alternative treatment to aortocoronary bypass in cases of favourable anatomy with high procedural success and no 6-month mortality in patients with good LV function. In patients in whom CABG is contraindicated, PTCA can be used as a balliative strategy in abating ischaemic symptoms. In this group, short-term prognosis relates to concomitant cardiac or extracardiac disease.