What does PCI (Percutaneous Coronary Intervention) stand for?

PCI Stands for Percutaneous Coronary Intervention

PCI stands for Percutaneous Coronary Intervention, which is a non-surgical procedure used to treat narrowed or blocked coronary arteries through the use of a catheter-based approach 1.

Definition and Components of PCI

PCI is a therapeutic intervention that treats coronary artery stenoses or occlusions to restore blood flow. It involves:

• Balloon dilation (angioplasty)
• Typically stent placement
• Sometimes atheroablative technologies 2

The procedure is performed by introducing a catheter system through a systemic artery under local anesthesia, then advancing it to a stenotic coronary artery where controlled inflation of a distensible balloon is used to open the blockage 3.

Historical Context

PCI has evolved significantly over time:

• Previously known as PTCA (Percutaneous Transluminal Coronary Angioplasty) in earlier guidelines 1
• Initially performed as a separate procedure following diagnostic coronary angiography (staged PCI)
• Now commonly performed immediately following diagnostic catheterization (ad-hoc PCI) 3

Clinical Applications of PCI

PCI is used in various clinical scenarios:

1. Primary PCI for STEMI:

   • Preferred reperfusion strategy for ST-elevation myocardial infarction when available within appropriate timeframes 2
   • Emergency PCI is the standard of care for STEMI patients, provided it can be delivered in a timely fashion by an experienced operator and cardiac catheterization laboratory team 4

2. PCI for Non-ST Elevation ACS:

   • Early angiography (≤48 h) and PCI when needed has shown clear benefit in high-risk groups 1

3. PCI for Stable Coronary Artery Disease:

   • Considered when significant ischemia is demonstrated and anatomy is suitable 2
   • Valuable initial mode of revascularization in patients with objective large ischemia in almost every lesion subset, except chronic total occlusions that cannot be crossed 1

Procedural Considerations

Important aspects of PCI procedures include:

• Timing: For primary PCI in STEMI, time is critical ("time is muscle") 4
• Imaging guidance: Intravascular imaging technologies (IVUS, OCT) provide detailed plaque characterization and guide stent sizing and deployment 2
• Adjunctive pharmacotherapy: Use of antiplatelet and antithrombotic medications is essential 1, 4
• Operator experience: Procedural volume of >75 cases per year is recommended for physicians performing PCI 1

Institutional Requirements

Guidelines recommend specific institutional standards for PCI programs:

• Minimal institutional performance activity of 200 interventions per year with an ideal minimum of 400 interventions per year
• Interventional program director with career experience of >500 PCI procedures and board certification in interventional cardiology
• High-resolution fluoroscopy and digital video processing equipment
• Experienced support staff to respond to emergencies 1

PCI has revolutionized the treatment of coronary artery disease by providing a less invasive alternative to coronary artery bypass grafting in many clinical scenarios, with ongoing technological advances continuing to improve outcomes.