Percutaneous coronary interventions

Percutaneous coronary intervention (PCI) is one of a host of techniques performed by using a catheter inserted via a major limb artery that aims to relieve nanowing of coronary arteries. For example, percutaneous transluminal coronary angioplasty (PTCA) is the classic PCI that uses a catheter-directed balloon to dilate a stenotic coronary artery, and more recent PCIs include stent implantation, rotational atherectomy, and laser angioplasty. 

Devise a pharmacotherapy treatment plan for a patient undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction given patient-specific data. 

Early reperfusion therapy with either primary percutaneous coronary intervention or administration of a fibrinolytic agent within 3 hours of symptom onset is the recommended therapy for patients presenting with ST-segment elevation acute coronary syndrome. 

Popma JJ, Berger P, Ohman EM, et al. Antithrombotic therapy during percutaneous coronary intervention. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004 126(Suppl) 576S-599S. 

Percutaneous coronary intervention A minimally invasive procedure whereby access to the coronary arteries is obtained through the femoral artery up the aorta to the coronary os. Contrast media is used to visualize the coronary artery stenosis using a coronary angiogram. A guidewire is used to cross the stenosis and a small balloon is inflated and/or stent is deployed to break up atherosclerotic plaque and restore coronary artery blood flow. The stent is left in place to prevent acute closure and restenosis of the coronary artery. Newer stents are coated with antiproliferative drugs, such as paclitaxel and sirolimus, which further reduce the risk of restenosis of the coronary artery. 

Patient symptoms, past medical history, ECG, and troponin or CK-MB determinations are used to stratify patients into low, medium, or high risk of death or MI or likelihood of needing urgent coronary angiography and percutaneous coronary intervention (PCI). 

Toutouzas K, Colombo A, Stefanadis C. Inflammation and restenosis after percutaneous coronary interventions. Eur Heart J 2004 25 1679-1687. 

Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G Carr J, Cohen EA, Betriu A, Desmet W, Kereiakes DJ, Rutsch W, Wilcox RG de Feyter PJ, Vahanian A, Topol EJ. (2003) Bivalirudin and provisional glycoprotein Ilb/IIIa blockade compared with heparin and planned glycoprotein Ilb/nia blockade during percutaneous coronary intervention REPLACE-2 randomized trial. J Am Med Assoc (JAMA) 289 853-863. 

Acute coronary syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave Ml) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or coronary artery bypass graft (CABG), clopidogrel has been shown to decrease the rate of a combined endpoint of cardiovascular death. Ml, or stroke, as well as the rate of a combined endpoint of cardiovascular death. Ml, stroke, or refractory ischemia. 

Percutaneous coronary intervention (PCI) As an anticoagulant in patients with or at risk for HIT undergoing PCI. 

The safety and efficacy of bivalirudin have not been established in patients with acute coronary syndromes who are not undergoing percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). 

For patients with chronic CAD, nuclear imaging is essential for addressing the following major clinical issues (i) detection of ischemic myocardium, (ii) differentiation between viable hibernating or stunned myocardium and scar tissue in mechanically dysfunctional regions, and (ill) risk stratification for future major adverse events. Such information provides the basis for percutaneous coronary intervention (PCI) or coronary artery bypass (CAB) surgery and assessing their outcomes based on detection of residual ischemia and recovery of contractile function. 

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