AHA Scientific Position

Percutaneous coronary intervention (PCI) encompasses a variety of procedures used to treat patients with diseased arteries of the heart, for example, chest pain caused by a build-up of fats, cholesterol, and other substances from the blood (referred to as plaque) that can reduce blood flow to a near trickle, or a heart attack caused by a large blood clot that completely blocks the artery.

Typically, PCI is performed by threading a slender balloon-tipped tube – a catheter – from an artery in the groin to a trouble spot in an artery of the heart (this is referred to as percutaneous transluminal coronary angioplasty – also known as PTCA, coronary artery balloon dilation or balloon angioplasty).  The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed coronary artery so that blood can flow more easily.  This is often accompanied by inserting an expandable metal stent.  Stents are wire mesh tubes used to prop open arteries after PTCA. (For more about stents, see the entry on Stent Procedure in this Encyclopedia.)

ACC/AHA/SCAI Guidelines

A joint 2005 American College of Cardiology/ American Heart Association/ Society for Cardiovascular Angiography and Interventions report gives guidelines for the management of patients undergoing PCI.  The report strongly recommends that PCI should be performed in facilities that have an experienced cardiovascular surgical team available as emergency backup for all procedures.

For patients suffering the crushing pain of a heart attack, a lifesaving trip may be to a hospital prepared to quickly open the blocked artery by inflating a small balloon and inserting a tiny metal structure called a stent to act as permanent scaffolding.  The goal: to restore blood flow to the heart muscle within 90 minutes of the patient's arrival at the hospital.  Science shows that patients truly benefit from a 'door-to-balloon time' of 90 minutes or less.  PCI done in this emergency circumstance is referred to as “primary” PCI.  Other PCI procedures, such as those done to unblock an artery before a heart attack occurs, are referred to as “elective” PCI.

In the past few years, there have been dramatic advances in PCI techniques, devices, and medications.  Drug-eluting stents are among the most notable.  These stents not only prop open the artery, they also slowly release medication that prevents the overgrowth of scar tissue that can renarrow the artery and block blood flow to the heart, a complication known as restenosis.

Additional highlights of the guidelines include:

• Updated recommendations on using anti-clotting medications, such as clopidogrel, low molecular-  weight heparin, and bivalirudin, before, during, and after PCI;
• A recommendation that new protective devices be used to trap bits of plaque and blood clots that can break loose during PCI of aging veins from the legs transplanted to the heart during coronary artery bypass surgery;  
• A detailed analysis of the circumstances under which PCI is the best treatment for heart attack;
• A recommendation for early follow-up of patients who have PCI of the left main coronary artery, which supplies blood to a large portion of the heart muscle; and
• Strategies for ensuring the best possible patient outcomes and for monitoring quality of care.

Finally, requirements were outlined for institutional and physician competency – including quality assurance and institutional and physician volume of procedures done .

Related AHA publications:

• Heart and Stroke Facts
• Your PTCA brochure
• "What Is Coronary Angioplasty?" in Answers By Heart kit

Related AHA Scientific Statements:
Angioplasty