Interventional cardiology: in search of the balance between ischaemia and bleeding

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] The introduction of any foreign body into the circulation, be it a catheter, a balloon, and/or a stent, as is common practice in interventional cardiology, is associated with a risk of thrombus formation. Therefore, from the very beginning, anticoagulants, and later platelet inhibitors, have been used prior to, during, and after such procedures. Any such measure, whether anticoagulants1,2 and/or platelet inhibitors,3 is associated with an increased risk of bleeding at the entry site and/or in other organs such as the skin, gastrointestinal and urinary tract, and/or the brain. Of note, bleeding has been associated in multiple studies with long-term outcome, including mortality.4 The degree and duration of inhibition of the coagulation cascade or of circulating platelets is of crucial clinical importance. For patients with stable coronary artery disease (CAD5) or those with an acute coronary syndrome (ACS)6,7 receiving a modern drug-eluting stent (DES), the current European Society of Cardiology (ESC) Guidelines recommend 3–6 and 12 months, respectively. However, the issue remains unresolved following the results of several recent trials, which have come up with diverging conclusions. This is outlined in the Editor's Page entitled ‘ Duration of dual antiplatelet therapy after coronary artery stenting: where is the sweet spot between ischaemia and bleeding ?8 Although cardiogenic shock remains an often fatal complication of myocardial infarction,9,10 the introduction of primary percutaneous coronary intervention (PCI11) and mechanical support devices12 has markedly improved prognosis. In a timely Clinical Review article entitled the ‘ Management of cardiogenic shock ’, by Holger Thiele from Lubeck in Germany, the progress achieved is discussed … [1]: /embed/inline-graphic-1.gif