Table of ContentsView AllTable of ContentsIndicationsLimitationsBenefits
Table of ContentsView All
View All
Table of Contents
Indications
Limitations
Benefits
Having a stent placed in your heart may improve your life expectancy, but it depends on factors like what condition the procedure is used to treat and your age and overall health.
Percutaneous coronary intervention (PCI) is a procedure that includes angioplasty and stenting. Research suggests that for some forms of coronary artery disease (CAD), PCI may be just as effective as conservative treatment with medication and lifestyle changes. For someone with acute coronary syndrome (ACS), however, early treatment with PCI can be life-saving.
This article discusses percutaneous coronary intervention, what it is used for, and how it impacts long-term survival.
SHUBHANGI GANESHRAO KENE / Getty Images
If you have been diagnosed withcoronary artery disease (CAD),you may be offered percutaneous coronary intervention (PCI), a non-surgical procedure comprised of two different techniques:
Percutaneous coronary intervention is used to treat stenosis (narrowing) of the coronary arteries in people with CAD. It has different indications for use as well as different aims and outcomes.
PCI is sometimes used electively in people withstable anginaif the symptoms (chest pains, chest pressure) are difficult to control. In such cases, a PCI may provide temporary relief but will not cure the underlying condition.
Are Stents Really Needed for Stable Angina?
Percutaneous coronary intervention is appropriate for the treatment of certain cardiac events and less appropriate for others. It is not considered a “cure-all” for arterial stenosis or an inherently “better” option for treatment compared to optimal medical therapy (OMT).
In fact, a number of studies have shown that OMT—consisting ofdiuretics,beta-blockers,calcium channel blockers, nitrates, and the aggressivecontrol of blood pressureandcholesterol—can be just as effective as PCI in treating certain forms of CAD.
A few large-scale studies have confirmed this, including a 2020 study of 5,179 people with stable CAD receiving either angiography/revascularization and medical therapy or medical therapy alone and angiography/revascularization only if medical therapy was unsuccessful.
The study concluded that in people with stable CAD, angiography/revascularization as an initial strategy did not reduce the risk of all-cause death compared to medical therapy alone.
Interpreting the Findings
Other studies have tended to support this conclusion. In 2022, a meta-analysis of 10 randomized clinical trials found that when PCI is added to OMT, it does not reduce the rates of all-cause mortality or heart attack compared to OMT without PCI. However, this study also found that PCI and OMT together seemed to improve symptoms and reduce the risk of additional medical procedures.
Other studies have found drawbacks to PCI, including the potential for damage to the arterial wall.
Studies have also found that up to 12% of those receiving PCI will have to repeat the procedure within the first year.There is also evidence that people who undergo PCI don’t always take steps to promote continued heart health, such as reducing their consumption of red meat andunhealthy fats.
PCI is also associated with complications such as postoperative bleeding, heart attacks, andstroke.
In response to research, the American Heart Association and American College of Cardiology issued updated guidelines outlining the appropriate use of PCI in people with heart disease.In people with stable CAD, the guidelines stress lifestyle changes and the appropriate use of medications in first-line treatment. This includes aheart-healthy diet, routine exercise,smoking cessation, and adherence to daily drug-taking.For those with NSTEMI and unstable angina, clinical insight is needed to determine if other options are more appropriate, including CABG or OMT.
In response to research, the American Heart Association and American College of Cardiology issued updated guidelines outlining the appropriate use of PCI in people with heart disease.
In people with stable CAD, the guidelines stress lifestyle changes and the appropriate use of medications in first-line treatment. This includes aheart-healthy diet, routine exercise,smoking cessation, and adherence to daily drug-taking.
For those with NSTEMI and unstable angina, clinical insight is needed to determine if other options are more appropriate, including CABG or OMT.
What Are the Risk Factors for Coronary Artery Disease?
PCI is generally considered appropriate for the treatment ofacute coronary syndrome (ACS). ACS is the term used to describe the three forms of CAD in which blood flow to the heart is blocked either partially or completely:
STEMI
In people with STEMI, PCI significantly reduces the risk of death and illness as compared to OMT. If performed within 12 to 72 hours of the first appearance of symptoms, PCI can also reduce the extent and severity of heart muscle damage.
A 2015 study from France concluded that PCI performed within 24 hours of a STEMI event translates to a five-year survival rate of 85% compared to only 59% for those who receive no treatment.
NSTEMI and Unstable Angina
A 2010 review of studies published in theCochrane Database of Systematic Reviewsconcluded that the use of PCI in people with NSTEMI lowers the risk of a heart attack over the next three to five years but also doubles the risk of a heart attack during or soon after the procedure.
Summary
Angioplasty and stenting are two types of non-surgical interventions for people with coronary artery disease. These interventions may be used in emergencies or in non-emergency situations where there is a risk of serious events.
When to See a Cardiologist
12 Sources
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