Frontiers in Interventional Cardiology

With state of the art chapters on hot issues in the field as well as new developments and research, this book provides the most comprehensive coverage of this topic currently available.

Interventional cardiology is such a rapidly progressing discipline that textbooks run the risk of being outdated by the time they are printed. To keep track of all developments requires regular attendance at major meetings. Such a meeting was the Second International Meeting in Interventional Cardiology, held in Jerusalem in July 1997. Only a few months later, the highlights of this meeting have been published as a book with the ambitious title Frontiers in Interventional Cardiology. Unlike other proceedings, however, this is more than a summary of scientific papers; rather, it is an impressive document of the state of the art 20 years after the first coronary angioplasty procedure by Andreas Gruntzig.

In 40 chapters written mostly by opinion leaders in the field, the entire spectrum of percutaneous cardiac and peripheral interventions in adults and children is covered. The combination of clinical contributions with basic-research aspects is unique and compelling. Among the very practical contributions are those on the use of stents or intracoronary Doppler techniques, the management of multivessel disease, and the potential of new imaging methods. Outstanding overviews of basic-science aspects are interspersed with these chapters. The active operator in the catheterization laboratory, as well as the basic scientist, may find valuable information here. To stimulate conversation between clinical and basic research is a major aim of this book.

Stents have a central role throughout the book, which adequately reflects their great impact on the interventional treatment of coronary heart disease. Aspects of stenting, such as technical design, anticoagulation, and intravascular ultrasound-guided deployment, are addressed in detail in separate chapters. For better orientation in this jungle of information, several helpful tables present the technical data and list ongoing or completed trials. Some of this information is difficult to find elsewhere in such complete form.

The risk of restenosis remains the crucial shortcoming of interventional treatment, despite the growing use of stents. Recent concepts of the underlying mechanisms, derived from intravascular ultrasonography and histologic studies, are presented clearly. Among the new therapeutic options, radiation has lately attracted a great deal of interest. Current knowledge is thoroughly summarized, and the discussion can be recommended to everyone who wants to enter this field.

Special sections are reserved for molecular and vascular pathophysiology, as well as the physiology of coronary flow. The chapters on gene transfer for therapeutic angiogenesis and genetic engineering of stents deserve attention with respect to future treatment. Every contribution is well referenced, and the citations stimulate further interest.

Another section is devoted to such imaging methods as quantitative coronary angiography, intravascular ultrasonography, and angioscopy. Like the chapters on peripheral and noncoronary cardiac interventions, these are excellent overviews that provide information that will be useful in daily practice. The final section deals with pediatric interventions and may be recommended to cardiologists who treat adults and who wish to bring their knowledge up to date.

The editors of this book must be congratulated for bringing out this high-quality work in such a short time. Although it is a multiauthored book, the style is consistent and the level of information is remarkably high. However, one will not find answers to all questions regarding catheter-based interventions, and some aspects might have been given different weight by other authors. Studies of the use of glycoprotein IIb/IIIa-receptor blockers could be considered underrepresented in relation to their current role. Alternative techniques such as rotablation or laser methods may deserve greater attention. However, these criticisms do not negate the value of the book. It truly fulfills the editors' stated goal: "to set standards for the years to come."

Reviewed by Christian W. Hamm, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.