Interventional cardiology as a speciality is in cross roads.
The number of coronary interventions (PCI) has increased exponentially world over. With increasing Cath labs and growing expertise , access to PCI has enormously increased even in underdeveloped countries. Meanwhile , public lack specific technical information about the appropriateness of these costly procedures. It is our duty to do self audit on this issue. .
In this context, the evaluation following a PCI should look beyond lumen oriented endpoints. Many land mark trials on DES report 3 months are 6 months angiographic outcome and better luminal appearance . Many tend to worry more about the status of the stent rather than the patient ! This is primarily because the device companies have repeatedly stressed the technical end points rather than clinical end points .
It is a well recognised fact that ,stented coronary artery never guarantees against future coronary events (ACS) either within the stent or away from it .It is an explict fact that , a patient after getting a coronary stent , especially a drug eluting stent carries a life long risk of acute stent obstruction and possibly SCD .This information is rarely passed on to the patient in and hence they are not able to take “learned consent”
It is true , one gets a gratifying feeling when opening up a obstructed artery , but we also need to answer this simple question What is it’s impact on patient’s life ?
COURAGE & OAT trials have put a break on the prevailing precondtioned behaviour in the labs, namely any obstruction must be relieved if technically feasible .
One should recall the Gruentzig’s legacy . Whaterver, we do inside a patient’s coronary artery must have some useful purpose . We should not use patient’s coronary artery to show our expertise and skills !
Dr.S.Venkatesan, Madras Medical College, Chennai, India
Dr.S.Venkatesan MD 
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