Management of Patients after Percutaneous Coronary Intervention
Management of Patients after Percutaneous Coronary Intervention
The exponential increase in the numbers of percutaneous coronary interventions (PCIs) has led to many clinicians having to care for post-PCI patients. We review the management of early problems seen in post-PCI patients, such as vascular access site complications, contrast nephropathy, drug-induced thrombocytopaenia and chest pain. The management of possible restenosis and the use of stress testing are discussed. The complications from dual antiplatelet therapy are addressed. The prognosis of the post-PCI patient, the implications of co-existent heart failure and the newer technologies of implantable defibrillator and cardiac resynchronisation therapy are reviewed. We conclude by emphasising the importance of secondary prevention by risk factor modification as well as the communication between the clinician and the cardiologist.
Percutaneous coronary intervention (PCI) has evolved into an effective revascularisation strategy for coronary artery disease since its inception in 1977.
Landmark studies that demonstrate the benefits of PCIs have propelled the astronomical escalation of the numbers of PCI procedures performed every year. About 1.2 million PCIs are performed every year in the US alone, and 45,000 per year in the UK. This represents a fivefold increase in the number of PCIs every decade. It is increasingly likely that primary care physicians will come across patients who have received this type of therapy. The rapid technological advances in PCI therapy means that new techniques, together with their new complications, are seen ever more frequently. Therefore, there is a great need for regular review and updates for clinicians involved in the care of these patients. We will discuss the general management principles as well as specific issues raised by new technologies for these post-PCI patients.
The exponential increase in the numbers of percutaneous coronary interventions (PCIs) has led to many clinicians having to care for post-PCI patients. We review the management of early problems seen in post-PCI patients, such as vascular access site complications, contrast nephropathy, drug-induced thrombocytopaenia and chest pain. The management of possible restenosis and the use of stress testing are discussed. The complications from dual antiplatelet therapy are addressed. The prognosis of the post-PCI patient, the implications of co-existent heart failure and the newer technologies of implantable defibrillator and cardiac resynchronisation therapy are reviewed. We conclude by emphasising the importance of secondary prevention by risk factor modification as well as the communication between the clinician and the cardiologist.
Percutaneous coronary intervention (PCI) has evolved into an effective revascularisation strategy for coronary artery disease since its inception in 1977.
Landmark studies that demonstrate the benefits of PCIs have propelled the astronomical escalation of the numbers of PCI procedures performed every year. About 1.2 million PCIs are performed every year in the US alone, and 45,000 per year in the UK. This represents a fivefold increase in the number of PCIs every decade. It is increasingly likely that primary care physicians will come across patients who have received this type of therapy. The rapid technological advances in PCI therapy means that new techniques, together with their new complications, are seen ever more frequently. Therefore, there is a great need for regular review and updates for clinicians involved in the care of these patients. We will discuss the general management principles as well as specific issues raised by new technologies for these post-PCI patients.