DES: Past, Present and Future Perspectives

A least invasive and most effective therapy is the best treatment for patient with ischemic coronary heart disease. The ultimate goal of interventional cardiology is to substitute coronary artery bypass grafting (CABG), which is a more invasive form of treatment, for less invasive percutaneous revascularisation (PCI). Whether this goal is achievable in the near future remains unknown, however, the aim should be clearly recognized for both interventional cardiologist and cardiac surgeon. Recent multicenter studies comparing PCI using drug eluting stent (DES) with coronary artery bypass surgery (CABG) have shown the similar morbidity and mortality for both treatment groups, although overall cardiac events was significantly less in cardiac surgery groups. While Andreas Gruentzig dreamed to maintain the patient in the single vessel or non-significant disease condition using percutaneous revascularisation (PCI), we have many patients who had three or more coronary interventions on different coronary arteries at different times. Although there is still a philosophical gap between the interventional cardiologist and cardiac surgeon, It still remains to be debated whether several relatively less invasive procedures using DES would be really better than a single extremely invasive one.