Coronary angioplasty in the United States

Coronary angioplasty has evolved in the twenty years since its introduction to become the procedure of choice for a wide variety of coronary lesions and ischemic presentations. Optimal results require highly trained cardiologists who perform procedures frequently, high volume centers with well trained staff, proper selection of patients and lesions, availability of adjunctive devices such as atherectomy and stents, appropriate use of available pharmacologic agents, appropriate use of alternative therapies such as bypass surgery and medical therapy, and close working relationships with surgical teams. With such an approach, procedural success rates should be greater than 90%, emergency bypass rates around 1%, and mortality well under 1%. As equipment, technique, and understanding of the endovascular environment improve, angioplasty will continue to be an important part of the overall treatment of patients with coronary artery disease.