It is my great honour to join Interventional Cardiology Review as Coronary Section Editor. In the modern era we are all increasingly busy and it is a pleasure to be part of a journal that helps to maintain an up-to-date knowledge of clinical practice.
I practice as an Interventional Cardiologist in a univesrsity hospital in Hull, UK, and have a particular interest in undertaking complex coronary interventions. I have a clinical research background, founded more than 10 years ago during a PhD Fellowship in Rotterdam under the supervision of Professor Patrick W Serruys. Since then, I have continued to undertake clinical research projects, particularly in challenging areas such as chronic total occlusions. I hope to bring my clinical, as well as my research, interests to influence the Coronary Section Editor role at Interventional Cardiology Review.
I have been lucky enough to regularly travel to meetings all over the world and keep abreast of new developments in our field. We have an exciting year ahead of us with several important clinical trials due to report. In particular, the results of the EXCEL (Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization) studies could impact greatly on our therapy of left main stem disease. In many parts of the world, left main stem lesions are still very much the domain of our cardiac surgery colleagues, however these trials have the potential to alter practice if the angioplasty results are as favourable as anticipated. The field of stent design has undergone huge transformation in recent years and continues to evolve. I am particularly looking forward to learning more about current and new bioabsorbable stent technologies.
Advances in the field not withstanding, there remain several important on-going issues in interventional cardiology that are not yet fully clarified. One area is that of anti-platelet therapy: the battle between balancing the need for anti-platelet therapy to reduce the catastrophic event of stent thrombosis, and the risk of bleeding which, too, can be disastrous for the patient. Every day, we use our clinical judgement to weigh up these risks and individually tailor patient management. However, questions remain. How can we better predict bleeding? What is the ideal type, dose, and duration of anti-platelet therapy? What about patients who require anti-coagulation? This clinical problem is becoming even more pertinent in contemporary practice as our population ages. It is now common to undertake coronary interventions on patients aged >80 years, however there is a paucity of evidence in this age group. Such interventions are often more complex; however, although the risks are higher, these patients have potentially the most to gain. Quality of life in this age group is commonly felt to be more important than longevity. We need specific research in this population so that we can improve risk stratification in older patients, as well provide an evidence-base to guide best practice.
There are still challenges in the field of coronary intervention. A particularly challenging patient group is those with refractory angina who do not have a revascularisation option perhaps because of diffuse, distal disease. Such patients have poor quality of life as well as an increased mortality rate. Although there have been several pharmacological and non-pharmacological treatments shown to improve quality of life, convincing evidence regarding reduction in ischaemic burden and mortality is lacking. Furthermore, technologies such as coronary sinus occlusion and enhanced external counter-pulsation are not widely funded / available. More work is needed to continue to develop these concepts as well as other therapies such as arteriogenesis that have the potential to transform the management of patients with otherwise “untreatable” disease. These technologies may also have a role to facilitate the treatment of chronic total occlusions (CTOs) where the highest success rates are seen only in the hands of experts. Other innovations might include “forward-looking” imaging technology – could this facilitate a high successful recanalization rate for all operators performing CTO angioplasty?
Comprehensive reviews are important to clarify best practice and I am impressed by the quality of the articles published in Interventional Cardiology Review. The journal has a great team in place and it is a pleasure to work with them to continue to develop and maintain the journal’s high standards. Comments and feedback from readers would be very much welcomed; my aims are to continue to develop the journal, increase its readership, and maintain its reputation for quality.