The history of invasive cardiology begins with the development of cardiac catheterization in 1711, when Stephen Hales placed catheters into the right and left ventricles of a living horse.
Cardiac catheterization was first performed when Werner Forssmann, in 1929, created an incision in one of his left antecubital veins and inserted a catheter into his venous system.
[3] Over the next year, catheters were placed in a similar manner into the right ventricle, and measurements of pressure and cardiac output (using the Fick principle) were performed.
[5] For their work in the discovery of cardiac catheterization and hemodynamic measurements, Cournand, Forssmann, and Richards shared the Nobel Prize in Physiology or Medicine in 1956.
[6] In 1958, Interventional Radiologist, Dr. Charles Dotter began working on methods to visualize the coronary anatomy via sequential radiographic films.
[7] Later that same year, while performing an aortic root aortography, Mason Sones, a pediatric cardiologist at the Cleveland Clinic, noted that the catheter had accidentally entered the patient's right coronary artery.
[8] While the patient went into ventricular fibrillation, the dangerous arrhythmia was terminated by Dr. Sones promptly performing a precordial thump which restored sinus rhythm.
[17] Soon after Andreas Gruentzig began performing percutaneous interventions on individuals with stable coronary artery disease, multiple groups described the use of catheter-delivered streptokinase for the treatment of acute myocardial infarction (heart attack).
[22] It was quickly realized that restenosis rates were significantly lower in individuals who received an intracoronary stent when compared to those who underwent just balloon angioplasty.
[24][25] Initial results with the Palmaz-Schatz stents were excellent when compared to balloon angioplasty, with a significantly lower incidence of abrupt closure and peri-procedure heart attack.
Trials in the late 1990s revealed that anticoagulation with warfarin was not required post balloon angioplasty or stent implantation, while intense anti-platelet regimens and changes in procedural technique (most importantly, making sure that the stent was well opposed to the walls of the coronary artery) improved short term and long term outcomes.
[47] Several of these studies evaluate the effectiveness of newer techniques, such as fractional flow reserve (FFR), and suggest PCI can frequently improve outcomes for patients with clinically significant coronary atherosclerosis.
[48] The FAME study found that the primary endpoint of death, nonfatal myocardial infarction, and repeat revascularization were 5.1% lower after one year in patients whose care was guided by FFR.
Data analysis of COURAGE trial results showed an incremental benefit for patients during the first 12-24 months following treatment using PCI, specifically regarding frequency of angina, physical limitations, and quality-of-life factors.
[52] Results from a 2019 trial did not show evidence that an initial invasive strategy reduced the risk of ischemic cardiovascular events or death from any cause.
[54] When results from the first trials of drug-eluting stents were published, there was a general feeling in the interventional cardiology community that these devices would be part of the perfect revascularization regimen for coronary artery disease.
During this time of uncertainty, many cardiologists started extending the dual antiplatelet regimen of aspirin and clopidogrel in individuals with drug-eluting stents, as some data suggested it may prevent late thrombosis.
[43] The FDA advisory board reiterated the ACC guidelines that clopidogrel should be continued for 12 months after drug-eluting stent placement in individuals who are at low risk for bleeding.
[65] Advancements in stent design that include reducing strut thickness have shown further improvements for patients compared to previous generations.