Article updated and reviewed by Mark I. Furman, MD, FACC, FAHA, Director of Interventional Cardiology, UMass Memorial Medical Center & Associate Professor of Medicine and Cell Biology, University of Massachusetts Medical School on December 21, 2005.
The initial technique of percutaneous coronary intervention, coronary angioplasty, was to widen narrowed coronary arteries by inflating a small balloon catheter at the site of the narrowing. The current standard of care usually results in the placement of a metal tube called a stent at the site of the narrowing. The stent functions to keep the artery open. Many stents now are coated with drugs to help prevent scar tissue formation and therefore reduce the need for repeat procedures. Because of the rapidly changing techniques and the association of the term “angioplasty” with balloon inflation only, these heart procedures are now referred to as percutaneous coronary interventions (PCI).
Who Is Eligible for Percutaneous Coronary Intervention?
Patients with narrowings or blockages of any of their heart arteries are potentially eligible for PCI. These narrowings generally cause chest pain referred to as angina; however, the presence of angina is not necessary for a PCI to be performed. There is a wide range of patients who can benefit from PCI, including patients with discrete blockages in one artery at one end of the spectrum to patients with blockages in multiple coronary arteries at the other end of the spectrum. PCI is now considered the treatment of choice for patients who have suffered heart attacks.
The question as to whether a patient would benefit from coronary artery bypass graft surgery (CABG) as opposed to PCI is based on the extent of the blockages within the arteries, whether a PCI is likely to have both short-term and long-term success, and the overall pumping function of the heart. Also, the overall medical condition of the patient plays a significant factor as well. Compared to CABG, PCI generally costs less and involves a shorter period of hospitalization.
Neither PCI or CABG cures the underlying disease in the coronary artery. In fact, the procedure may have to be repeated to reopen the same or another artery that becomes blocked. Drug-eluting stents have significantly reduced the need for repeat procedures. As with all patients with heart disease, those undergoing PCI are at risk for recurrent cardiac events. This risk is significantly reduced by the use of medications including aspirin, clopidogrel (plavix), and cholesterol-lowering agents such as statins. In addition, dietary modification, exercise, weight reduction, and stopping smoking are also highly recommended to every patient undergoing PCI.
Best outcomes for PCI are associated with physicians who perform large numbers of PCIs per year in centers that also perform high number of PCIs per year. Therefore you should ask your doctor the following questions:
Are you board-certified in Interventional Cardiology?
How many PCIs do you perform annually?
How many PCIs are performed each year in the hospital that you use?
What percentage of your patients have a heart attack, need emergency bypass surgery, or die as a direct result of the PCI?
How does this rate compare to national averages?
Will there be surgical backup in case of an emergency?
Editorial review provided by VeriMed Healthcare Network.