Heart disease, and more specifically coronary artery disease, is common in the U.S. Coronary artery disease is a build-up of cholesterol plaque in the arteries that supply the heart. When the degree of narrowing from plaque becomes severe, patients may suffer symptoms such as chest pain or pressure. If the plaque expands and ruptures, a heart attack ensues. Fear of the consequences of a diagnosis and possible need for open heart surgery can cause people not to seek care for chronic chest pain.
Specialized therapy called percutaneous coronary intervention (PCI) has provided a safe, effective option to relieve chronic chest pain without the need for open-heart surgery. It is also the preferred method to open an artery and stop a person’s heart attack quickly to prevent further damage to the heart muscle.
Cardiologists began to use PCI widely in the late ’90s and early 2000s. Since then, we’ve perfected its use and have achieved excellent success rates with the procedure.
How does PCI work?
Two groups of people who most often benefit from PCI are those with chronic chest pain from coronary artery disease and those in the midst of suffering a heart attack.
People with coronary artery disease may develop worsening chest pain over time. Patients may undergo cardiac stress testing, in which a doctor measures the performance of the heart and noninvasively screens patients for evidence of blocked coronary arteries. If the stress test produces abnormal results, the doctor may refer the patient to the cardiac catheterization lab for an outpatient cardiac catheterization procedure with possible PCI (also called coronary angioplasty) within a few weeks.
In contrast, a person might be seen in the emergency room with chest pain or other heart attack symptoms. In the emergency room, a patient might have an electrocardiogram (ECG or EKG) and blood tests to confirm the diagnosis of heart attack. Then, the interventional cardiology team will prepare the individual for cardiac catheterization and PCI right away to treat the heart attack and reduce long-term damage to the heart muscle.
During the procedure, patients are given a moderate sedative. We tailor the level of sedation to every patient’s individual condition and comfort level. The procedure begins with accessing a patient’s artery with a thin, flexible tube, most often in the patient’s wrist or groin.
Next, diagnostic images are taken with an X-ray camera so we can visualize the coronary arteries and determine the extent of any blockages. If an artery is significantly blocked, a balloon is inserted into the coronary artery to open the vessel up during the same procedure. Then, a stent, which acts like a scaffolding, is inserted into the artery to keep it open. Patients who have outpatient procedures often are discharged the same day, while patients referred through the emergency room might be observed overnight. Lifestyle changes and medications are critical to keep stents open and prevent further buildup of plaque in the arteries.
Experience matters for PCI therapy
If the artery is severely blocked or a patient is suffering with another health complication, it’s vital to seek the expertise of an interventional cardiology team. Though PCI has become somewhat routine, it’s a technical procedure that requires specialized training for stent placement and follow-up care.
The UT Southwestern interventional cardiology team performs complex PCIs on critically ill patients with special support equipment that helps the heart pump more effectively during the procedure. Working closely with our cardiothoracic surgery team, we can provide mini-consultations during a cardiac catheterization so we can be certain that stenting will be as effective or better for a particular patient than open-heart surgery. This type of team support is vital to patient safety and effective disease management.
If chronic chest pain from coronary artery syndrome affects your quality of life, ask your cardiologist if PCI is an appropriate option for you. This short, safe procedure can help you feel better day to day and improve blood flow to your heart.
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