The number of major adverse cardiac events among PCI patients has declined since the procedure was introduced in the U.S., even as patients' risk profiles have increased, according to a trends study of 3.3 million patients published in the American Heart Journal. The study examined three-year outcomes across three eras -- balloon angioplasty, bare-metal stents and drug-eluting stents. The lowest rate of MACE at three years, 44%, occurred in the DES era. "Patients we are seeing in the OR and cath lab today include many who in the past would have been deemed too high-risk and would have been treated medically," said SCAI fellow Dr. Sunil V. Rao, a study author. "If we are to improve, it will be in these very, very high-risk patients -- those in shock, in cardiac arrest, with a last remaining vessel."