The presenter of today’s ESC Andreas Grüntzig Lecture in Interventional Cardiology is Professor Marco Valgimigli (Cardiocentro Ticino Institute - Lugano, Switzerland) who will discuss why he thinks interventional pharmacology should become a subspecialty in its own right.
“Since the introduction of interventional cardiology by Andreas Grüntzig in the 1970s, its main focus has been on the use of devices. Pharmacology is, of course, considered but generally only in the context of supporting a device. For example, in the coronary space, we have spent years evaluating anticoagulants and antiplatelet therapies to protect stents – employing device-specific endpoints in trials, for example. We have overlooked the fact that devices are embedded in patients and there is always a global outcome that needs to be taken into account. To this end, a device should not be regarded as a standalone entity. Nor should pharmacology be seen as an accessory to the device’s function. Instead, the individual elements should be viewed as part of a combined device-pharmacology strategy, with connectedness between the two, to make treatment more effective and possibly safer for our patients.
There is so much to be learned about this novel concept, including the most effective combinations of drugs and devices, the most appropriate timings and the patient groups who will benefit most from the different approaches. For example, looking at stroke prevention, we know that the use of anticoagulants alone is more effective than left atrial appendage occlusion alone. What we don’t know is whether the combination of these two approaches would be more beneficial, at least in some patients, than the individual treatments. As another example, further studies would be beneficial to explore interactions between mitral valve interventions and medical therapies in heart failure.
I am convinced that recognition of interventional pharmacology as a new subspecialty within interventional cardiology is the way forward to achieve real progress. I realise that this will require a change of mindset for the interventional community but I am confident that it is more than equal to this. I also believe that it is the medical community, collaborating to bring together specialists in the fields of device and of pharmacological intervention, that is best placed to lead the call for this combined approach, which has the potential to greatly improve outcomes for our patients.”