Percutaneous Coronary Interventions
Atherosclerosis is a dynamic process and timely introduction of pharmacological treatment can have a significant bearing on the patient's health and outcome. In addition to treating the culprit lesion mechanically, admission for percutaneous coronary interventions (PCI) for coronary artery disease (CAD) gives an opportunity for the interventional cardiologist to optimize medical therapy. The aim of this review is to provide an overview of the current medical literature pertaining to cardiovascular (CV) risk reduction and vascular event prevention in the setting of PCI, with emphasis on antiplatelet therapies, β-blockers, HMG-Co A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors, with regard to therapy optimization during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure.
Atherosclerosis is a chronic and progressive disease. Patients with coronary artery disease (CAD) presenting for percutaneous coronary intervention (PCI) need to be systematically assessed for medical optimization in addition to implementing lifestyle and risk-factor modification, both for the procedure and perhaps more importantly, in the long term.
In a recent audit of 42 UK centres, the incidence of periprocedural deaths following PCI is <3%, which appears to be declining over time. The advent of drug-eluting stents has also greatly reduced the risk of coronary restenosis and the need for repeat target vessel revascularization. However, the overall mortality and morbidity in the latter category of 'high-risk' CAD patients remains high. As the number of coronary interventions performed in the UK grows, with an increase in the number of angiographic centres and operators, the interventional cardiologist is in an ideal position to initiate changes to prevent cardiovascular (CV) events in this group. This agenda can be achieved by a structured implementation of a programme of smoking cessation, lipid modification, and exercise and lifestyle intervention, together with aggressive medical therapies. Unfortunately, secondary prevention is still generally underused in patients undergoing PCI, but can still be optimized predischarge.
The aim of this review is to provide an overview of the current medical literature pertaining to CV risk and event prevention in the setting of PCI for CAD, with emphasis on antiplatelet therapy, β-blockers, statins and angiotensin-converting enzyme inhibitors (ACEi), therapy during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure. Initially, we review the drugs given peri-PCI and discuss the impact on outcome. In the second section, the effect of therapy optimization postprocedure will be reviewed.
We performed a search by using electronic databases (MEDLINE, EMBASE and DARE) and additionally, abstracts from national and international meetings were reviewed in order to identify unpublished studies. Relevant authors of these studies were contacted to obtain further data. The extensive literature on intravenous antiplatelet therapies, such as the glycoprotein IIb/IIIa inhibitors, are beyond the scope of this overview, which concentrates on oral medical therapies.
Atherosclerosis is a dynamic process and timely introduction of pharmacological treatment can have a significant bearing on the patient's health and outcome. In addition to treating the culprit lesion mechanically, admission for percutaneous coronary interventions (PCI) for coronary artery disease (CAD) gives an opportunity for the interventional cardiologist to optimize medical therapy. The aim of this review is to provide an overview of the current medical literature pertaining to cardiovascular (CV) risk reduction and vascular event prevention in the setting of PCI, with emphasis on antiplatelet therapies, β-blockers, HMG-Co A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors, with regard to therapy optimization during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure.
Atherosclerosis is a chronic and progressive disease. Patients with coronary artery disease (CAD) presenting for percutaneous coronary intervention (PCI) need to be systematically assessed for medical optimization in addition to implementing lifestyle and risk-factor modification, both for the procedure and perhaps more importantly, in the long term.
In a recent audit of 42 UK centres, the incidence of periprocedural deaths following PCI is <3%, which appears to be declining over time. The advent of drug-eluting stents has also greatly reduced the risk of coronary restenosis and the need for repeat target vessel revascularization. However, the overall mortality and morbidity in the latter category of 'high-risk' CAD patients remains high. As the number of coronary interventions performed in the UK grows, with an increase in the number of angiographic centres and operators, the interventional cardiologist is in an ideal position to initiate changes to prevent cardiovascular (CV) events in this group. This agenda can be achieved by a structured implementation of a programme of smoking cessation, lipid modification, and exercise and lifestyle intervention, together with aggressive medical therapies. Unfortunately, secondary prevention is still generally underused in patients undergoing PCI, but can still be optimized predischarge.
The aim of this review is to provide an overview of the current medical literature pertaining to CV risk and event prevention in the setting of PCI for CAD, with emphasis on antiplatelet therapy, β-blockers, statins and angiotensin-converting enzyme inhibitors (ACEi), therapy during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure. Initially, we review the drugs given peri-PCI and discuss the impact on outcome. In the second section, the effect of therapy optimization postprocedure will be reviewed.
We performed a search by using electronic databases (MEDLINE, EMBASE and DARE) and additionally, abstracts from national and international meetings were reviewed in order to identify unpublished studies. Relevant authors of these studies were contacted to obtain further data. The extensive literature on intravenous antiplatelet therapies, such as the glycoprotein IIb/IIIa inhibitors, are beyond the scope of this overview, which concentrates on oral medical therapies.
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