Preface

The Big Heart Disease Lie

How To Prevent Cardiovascular Disease Naturally

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Radical, maximally invasive surgery was performed for the preparation of this fifth edition of Textbook of Interventional Cardiology. There are over 30 new chapters and 70 new authors, for a complete revamping of the coverage of the ever-burgeoning field of interventional cardiology.

Section 1, Patient Selection, which is now considered highly important, is new to this edition. As percutaneous interventions have supplanted surgical ap- proaches for many types of patients and anatomical subsets, the risk and benefit assessment is critical. New chapters dedicated to arterial inflammation at baseline, which may be quite pivotal for long-term prognosis; functional testing, especially with multidetector CT angiography; and demographics, such as gender, ancestry, diabetes, and renal disease, have been added to help guide cardiologists in patient selection. An overview of evidence-based practice in interventional cardiology helps pull much of this together.

The complexity of coronary interventions has drastically changed, with approaches to left mainstem lesions that are unprotected, complex bifurcations, and diffuse disease now more common. Chapters on these topics, as is the case throughout the book, are written by international authorities. New chapters on transradial intervention and peri-access site management, which may be an important segue to facilitate outpatient intervention, are especially pragmatic.

The past year has been checkered in the field, with marked public attention given to late thrombosis of drug-coated stents and the results of the COURAGE trial. Late stent thrombosis, to which a new chapter is dedicated, is certainly a lingering concern that has led to more prolonged dual antiplatelet therapy and a shift in practice in the United States toward more bare metal stents. While the incidence of late stent thrombosis is quite low, we clearly need more information in order to prevent this dreaded complication. The COURAGE trial sparked debate as to whether percutaneous coronary intervention procedures were even warranted as compared with a pharmacologic-only strategy. The trial had major shortcomings, but the most important was the selection of the endpoint of death or myocardial infarction. No prior trial had shown benefit for this endpoint in the history of interventional cardiology, so to anticipate that this could be possible defies any Bayesian or a priori knowledge of the field. While interventional cardiology has been under fire for these two issues, the hope is that this will settle with the realization that there has been truly remarkable and relentless progress in the field.

One of the most exciting frontiers is the transformation of select hospitals into interventional centers of excellence. Two new chapters address this opportunity. One tackles acute myocardial infarction and acute coronary syndromes. The other chapter deals with the concept of stroke centers, performing acute intervention on patients with evolving stroke.

What are the other new frontiers for this field? The book delves much more deeply into each type of "big artery," noncoronary intervention with the lower and upper extremities, mesenteric, renal, carotid, and cerebrovascular arterial beds, along with venous interventions. This is a major difference from the last edition—the practice of interventional cardiology now extends to virtually all of the major artery beds. Certainly intracardiac intervention is a promising new dimension, with intracardiac echo, left atrial appendage closure, and percutaneous repair of the mitral valve or aortic valve. Using catheter-based intervention for stem cell therapy, regeneration therapy, or angio-genesis are particularly topical and important research paths. And the same applies for detection of vulnerable plaque and the controversy of whether nonobstructive inflamed segments of arteries should undergo intervention to preempt plaque fissure, erosion, or rupture. All of these topics are covered in newly added chapters.

The chapters on quality of care and regulatory issues also are new and present salient perspectives on the practice and regulatory aspects of the field.

Cumulatively, this book not only has hopefully tracked the progress in the field but also has provided a futuristic perspective. Compared with the field when the first edition of this textbook was published in the 1980s, when all there was to work with were relatively primitive balloon angioplasty catheters and a bit of roulette as to whether a major coronary dissection would be induced, the practice of interventional cardiology today is unrecognizable. Rarely is just a balloon used, the procedure is almost invariably calm and predicatable, and now the real interventional cardiologist is "pan-vascular" and evolving to practice an "intracardiac" genre, facile in all of the noncoronary vasculature procedures including the ability to close a patent foarmen ovale or left atrial appendage, or perform transcatheter valve repair.

Of the five editions of this book, I believe this one has captured and anticipated the field better than any other. I am especially grateful to the 125 authors from all over the world who shared their expertise and have put together an unprecedented reference source for our field. Michael Goldberg and his book production team at Elsevier have been formidable supporters, providing an exceptional layout; Natasha Andjelkovic, executive publisher, and Agnes Byrne, developmental editor, also at Elsevier, were most helpful in getting this project off the ground, along with my prior editorial assistant, Donna Wasiewicz-Bressan. I also want to express my deepest thanks to my friend and colleague Dr. Paul Teirstein, who has shown me a whole new level of interventional cardiology since my arrival in La Jolla. We all hope that the interventional cardiologist will find this a particularly useful reference source for what still remains the most remarkable discipline in medicine—one in which immediate gratification for patients can be achieved, and long-term imaginative solutions to complex challenges just keep accruing at a breakneck pace.

Eric J. Topol

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