Percutaneous Coronary Intervention, Not All Roads Lead to Rome

Percutaneous coronary intervention (PCI) started with a first patient in Zurich, Switzerland, treated by Andreas Grüntzig on September 16, 1977. Having been part of that intervention, I enjoy the privilege of taking care of this patient since. He is still enjoying excellent health and needed only two additional percutaneous interventions in his coronary arteries after 23 and 37 years, respectively. PCI saw an unprecedented evolution to today’s role as the most common major medical intervention around the globe. As is typical for a success story, many people have been co-builders. Even more people have tried to contribute to PCI or even replace it with modifications or alternatives that do not benefit patients. This was not always recognised immediately but the only real breakthrough, the coronary stent, was finally recognised by all as the only necessary adjunct to the initial balloon. The achieved degree of perfection of PCI will make it hard, if not impossible, to improve upon it by a change of paradigm, while small adaptations will continue to be introduced because they do not need randomised trials for approval.