From the Guidelines
Percutaneous Coronary Intervention (PCI) is a non-surgical procedure used to treat narrowed coronary arteries in the heart, involving the insertion of a catheter with a balloon and often a stent to improve blood flow to the heart muscle. This procedure has become a widely accepted treatment option for patients with coronary artery disease, including those with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) 1. The majority of current PCIs involve balloon dilation and coronary stenting, with stenting contributing greatly to catheter-based revascularization by reducing the risk of both acute vessel closure and late restenosis 1.
Key Components of PCI
- Insertion of a catheter with a balloon through a blood vessel, typically in the groin or wrist
- Guiding the catheter to the blocked or narrowed coronary artery
- Inflating the balloon to compress the plaque against the artery wall, widening the vessel and improving blood flow to the heart muscle
- Placing a stent, a small mesh tube that remains in the artery to keep it open
- Use of antiplatelet therapy, usually aspirin and a P2Y12 inhibitor, after the procedure to prevent clotting and reduce the risk of complications
Types of Stents
- Bare-metal stents
- Drug-eluting stents, which release medication to prevent the artery from narrowing again
Indications for PCI
- Patients experiencing acute coronary syndromes
- Patients with stable coronary artery disease causing significant symptoms despite medical therapy
- Patients with UA/NSTEMI, particularly those with high-risk characteristics, as revascularization appears to be beneficial in these cases 1
Outcomes and Benefits
- High success rate of PCI in patients with UA/NSTEMI, with angiographic success achieved in 96% of patients in one study 1
- Reduced risk of acute vessel closure and late restenosis with stenting
- Improved blood flow to the heart muscle, reducing symptoms and improving quality of life
From the Research
Definition and Purpose of Percutaneous Coronary Intervention (PCI)
- Percutaneous coronary intervention (PCI) is a mainstay procedure for the treatment of coronary artery disease 2.
- The primary goal of PCI is to open up blocked coronary arteries, thereby restoring blood flow to the heart muscle 3, 4.
Evolution and Advances in PCI
- PCI techniques have evolved considerably since its advent in 1978, with changes in best practices for patient management following PCI 2.
- Recent technological advances in PCI have enabled more complex coronary disease to be treated, with a focus on safe, precision PCI approaches guided by physiology, imaging, and optimal lesion preparation 3.
Patient Management and Outcomes
- The long-term management of patients post-PCI should follow three main principles: lifestyle modification and reduction of risk factors, implementation of secondary prevention therapies, and timely detection of restenosis 2.
- PCI has been shown to reduce the overall risk of composite outcomes, including all-cause mortality, myocardial infarction, revascularizations, rehospitalizations, or stroke, compared to medical therapy alone in patients with stable coronary artery disease 5.
- However, the net clinical benefit of PCI compared to medical therapy remains uncertain, with some studies showing no significant difference in overall risk of all-cause mortality or myocardial infarction 6, 5.
Indications and Role in Clinical Practice
- PCI continues to play a significant role in the management of chronic coronary syndrome, particularly in patients with symptoms not well controlled by medical therapy 6.
- The choice of revascularization strategy must take into account the evidence, and PCI should be performed when indicated, with a focus on achieving complete revascularization and durable long-term results 3.