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Percutaneous Coronary Intervention
Background
Percutaneous coronary intervention (PCI) is a mainstay of treatment for coronary artery disease (CAD). There are approximately 18 million Americans with CAD, and one American will have a myocardial infarction (MI) approximately every 40 seconds. A patient will classically present to the emergency department with chest discomfort along with other signs/symptoms that are suggestive of MI, which will prompt an electrocardiogram (EKG). If the EKG demonstrates ST-segment elevations (STEMI), the patient will undergo emergent evaluation for PCI. If the EKG does not demonstrate ST-segment elevations, the patient will undergo further evaluation including possible stress testing and evaluation of biomarkers (cardiac enzymes). See Chapter 53: Stress Tests for more details about these tests. If the patient has high-risk clinical features or has abnormal stress testing, he/she will also undergo evaluation for PCI. PCI involves deploying a stent device within the lumen of the coronary artery to keep the vessel open, or patent. Stent, originally a name and therefore spelled with a capital “S,” is now so common a term and can be used as a noun with a lowercase “s” (“the patient received a stent”) or even as a verb (“he was stented last week”).
How to Use It
PCI is performed only after a coronary catheterization and angiogram are done. The coronary catheterization and angiogram are the diagnostic portion in which iodinated contrast dye is injected directly into the coronary arteries to visualize the arteries under a live X-ray (fluoroscopy) to diagnose areas of stenosis. Contrast-induced nephropathy is a possible adverse event, and the amount of dye that is used is related to the complexity of the case and the amount of vessel that needs to be intervened upon. See Chapter 17: Computed Tomography Scan for more details about iodinated contrast media. Once CAD is confirmed by coronary angiography, the interventional cardiologist will proceed to perform PCI on the culprit lesion(s) that have been diagnosed. The decision to intervene on a lesion factors into account multiple considerations including the acuity of the lesion, degree of stenosis, and location of the stenosis. If there are multiple lesions, the interventional cardiologist will consider intervention on the additional nonculprit lesions either at that time or at a later date depending on the stability of the patient.
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