The need for revascularization procedures will remain the same or increase in the next decade.

It has been stated that cardiovascular risk-reduction strategies such as lipid-lowering drug therapy will significantly decrease the need for coronary revascularization procedures nationally and worldwide by the end of the next decade. Because of a number of factors this decrease is unlikely to occur. First, there is every indication that the growth of the Canadian population will remain at least linear in the next decade. In addition, the population is aging, with the greatest increase in population occurring in the 'baby boom' group and those older. This phenomenon will place an unprecedented level of stress not only on the health care system in general but also on all services related to the care of patients with symptomatic coronary artery disease. It has been suggested that these increases will be offset by proven therapies to reduce the risk of cardiovascular events. However, studies show that therapies such as lipid-lowering drugs continue to be underused, due to physician as well as patient factors. Furthermore, the indications for coronary revascularization are expanding with new evidence showing benefits of direct PTCA in the setting of myocardial infarction, as well as cardiogenic shock in selected patients. In addition, PTCA of totally occluded coronary arteries will be performed more frequently with new studies showing benefits in this setting. The greatest impact on need for revascularization procedures will occur worldwide. The coronary artery disease epidemic that affected western society is just now beginning to emerge in developing countries. Studies in India and China show an alarming rise in the prevalence of cardiovascular risk factors and with it the rise in the shift of the burden of disease from infectious to cardiovascular etiology. All of these factors are likely to result in an unprecedented rise in the need for coronary revascularization procedures.