Percutaneous Coronary Intervention (PCI) for Coronary Artery Disease

What is percutaneous coronary intervention?

PCI is a nonsurgical, minimally invasive procedure that’s used to open coronary arteries that have become narrowed or blocked with plaque. This helps improve blood flow to heart tissue.

Having a PCI also typically involves the placement of a small mesh tube called a stent. This is placed after the doctor opens the artery and helps to keep the artery open after treatment.

Who’s a candidate for a percutaneous coronary intervention?

A doctor can use PCI to treat a heart attack. When PCI is used to restore blood flow to the heart during a heart attack, it’s called primary PCI.

PCI may also be performed for symptomatic relief in people with angina that doesn’t respond to treatment with medications. In some circumstances, PCI may be recommended to lower the risk of heart attack or death.

A doctor evaluates several factors to determine whether PCI is appropriate. These include:

• the nature, severity, and location of the blockages
• whether you have symptoms and, if so, how severe they are
• ability to tolerate blood-thinning medications
• whether you have any other underlying health conditions, called comorbidities
• your age
• your risk of having one or more complications of revascularization, often assessed with a risk score

What’s a percutaneous coronary intervention procedure like?

Typically, a cardiologist performs a PCI in a hospital. A cardiologist is a type of doctor who specializes in treating conditions that affect the heart.

Using X-ray imaging, your cardiologist guides a catheter through your blood vessels until it reaches your heart. This catheter is typically inserted into a blood vessel close to your groin or in an artery in your wrist. A special contrast dye helps your cardiologist see where the blockages are.

Next, a catheter with a balloon tip is used to open the artery. Once it’s in position, the balloon is inflated, which pushes the artery open. Then, your cardiologist typically places a stent to help the artery stay open.

A PCI can take between 30 minutes and 2 hours. Many people go home the same day. However, depending on your situation, you may need to stay in the hospital overnight.

What’s recovery like from a percutaneous coronary intervention?

When you leave the hospital, your care team will give you discharge instructions on:

• medications (people who’ve had a PCI with a stent placement need to take at least one antiplatelet drug for the rest of their lives)
• wound care
• diet and lifestyle recommendations
• when to resume activities

You can also ask your doctor whether you’re eligible for a cardiac rehabilitation program. The goal of this program is to improve your future cardiovascular health through exercise advice and training, nutrition and lifestyle counseling, and stress reduction.

How successful are percutaneous coronary interventions?

PCI can be lifesaving for people experiencing a heart attack. Indeed, researchers have noted that PCI improves heart attack survival rates.

PCI can also reduce angina symptoms in people with CAD. For example, the ISCHEMIA and FAME-2 clinical trials found that people receiving PCI and medical therapy had improved angina relief than medical therapy alone.

One 2020 study also found that PCI can prevent heart attack and death in people with unstable CAD. Researchers defined unstable CAD as individuals who:

• have had a heart attack but didn’t receive immediate PCI or coronary bypass surgery
• had previously received a PCI for a heart attack but still had coronary artery lesions
• experienced a non-ST-segment-elevation acute coronary syndrome

However, PCI doesn’t seem to lower the risk of heart attack in people with stable CAD. Stable CAD is defined as episodes of chest discomfort due to a coronary blockage that occurs with exertion and is quickly (within minutes) relieved with rest. It does not increase in frequency or severity.

Clinical trials, including COURAGE, ISCHEMIA, and FAME-2, found no significant difference in heart attack or death rate in people with stable CAD who had PCI with medical therapy and those who had medical therapy alone.

What are the potential risks of percutaneous coronary intervention?

Several complications can happen due to PCI, including:

• excessive bleeding
• infection
• damage to blood vessels or to the heart
• arrhythmias
• kidney damage
• heart attack or stroke due to blood clots generated during PCI
• an allergic reaction to the contrast dye
• re-narrowing of the affected artery

Serious complications with PCI are generally rare. Some factors can increase the risk of complications, such as older age, extensive heart disease, or preexisting kidney disease.

If you’re going to have a PCI, your doctor will explain the various risks associated with the procedure to you beforehand. Make sure to ask any questions or raise any concerns you may have during this time.

Takeaway

PCI is a procedure that’s used to treat CAD. It works by opening coronary arteries that have become narrowed or blocked due to plaque buildup. A stent is also often placed to help hold the artery open.

Having a PCI can be lifesaving if you’re having a heart attack. While PCI can improve angina symptoms and quality of life in people with stable CAD, it hasn’t been shown to reduce the risk of heart attack or death in this group.

Several risks are associated with PCI, including blood clots, infection, and damage to the blood vessels or heart. It’s important to go over these with your doctor before your procedure.