Post PCI management

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Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

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Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

PCI approaches

PCI Complications

Factors Associated with Complications
Vessel Perforation
Dissection
Distal Embolization
No-reflow
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Restenosis
Renal Failure
Thrombocytopenia
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Post-PCI Management

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (Please do not edit).

Dual Antiplatelet Therapy in Patients After PCI

Class IIa
" 1. In selected patients undergoing PCI, shorter-duration DAPT (1–3 months) is reasonable, with subsequent transition to P2Y12 inhibitor monotherapy to reduce the risk of bleeding events (Level of Evidence A)".

[1]

Beta Blockers in Patients After Revascularization

Class III (No Benefit)
"1. In patients with SIHD and normal left ventricular function, the routine use of chronic oral beta-blockers is not beneficial to reduce cardiovascular events after complete revascularization.(Level of Evidence:C-LD "

[1]

Antiplatelet Therapy in Patients With Atrial Fibrillation on Anticoagulation After PCI

Class I
"1. In patients with atrial fibrillation who are undergoing PCI and are taking oral anticoagulant therapy, it is recommended to discontinue aspirin treatment after 1 to 4 weeks while maintaining P2Y12 inhibitors in addition to a non–vitamin K oral anticoagulant (rivaroxaban, dabigatran, apixaban, or edoxaban) or warfarin to reduce the risk of bleeding (Level of Evidence: B-R)"

[1]

Class IIa
" 2. In patients with atrial fibrillation who are undergoing PCI, are taking oral anticoagu-lant therapy, and are treated with DAPT or a P2Y12 inhibitor monotherapy, it is reasonable to choose a non–vitamin K oral anticoagulant over warfarin to reduce the risk of bleeding (Level of Evidence B-R)".

[1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[2]

Post-procedural Antiplatelet Therapy (DO NOT EDIT)[2]

Class I
"1. After PCI, use of aspirin should be continued indefinitely.[3][4][5][6] (Level of Evidence: A)"
"2. The duration of P2Y12 inhibitor therapy after stent implantation should generally be as follows:
a. In patients receiving a stent (bare metal stent (BMS) or drug eluting stent (DES)) during PCI for ACS, P2Y12 inhibitor therapy should be given for at least 12 months. Options include clopidogrel 75 mg daily [7], prasugrel 10 mg daily [8], and ticagrelor 90 mg twice daily.[9] (Level of Evidence: B)
b. In patients receiving drug eluting stent (DES) for a non-ACS indication, clopidogrel 75 mg daily should be given for at least 12 months if the patient is not at high risk of bleeding.[10][11][12] (Level of Evidence: B)
c. In patients receiving bare metal stent (BMS) for a non-ACS indication, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).[13] (Level of Evidence: B)"
"3. Patients should be counseled on the importance of compliance with dual antiplatelet therapy (DAPT) and that therapy should not be discontinued before discussion with their cardiologist.[12] (Level of Evidence: C)"
Class IIa
"1. After PCI, it is reasonable to use aspirin 81 mg per day in preference to higher maintenance doses.[14][15][16][17][18] (Level of Evidence: B)"
"2. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of P2Y12 inhibitor therapy after stent implantation, earlier discontinuation (e.g., less than 12 months) of P2Y12 inhibitor therapy is reasonable. (Level of Evidence: C)"
Class IIb
"1. Continuation of clopidogrel, prasugrel or ticagrelor beyond 12 months may be considered in patients undergoing placement of drug eluting stent (DES).[8][9] (Level of Evidence: C)"

Post-Procedural Proton Pump Inhibitors and Anti-platelet Therapy (DO NOT EDIT)[2]

Class I
"1. Proton pump inhibitors should be used in patients with a history of prior gastrointestinal bleeding who require dual antiplatelet therapy (DAPT).[19] (Level of Evidence: C)"
Class III (No Benefit)
"1. Routine use of a proton pump inhibitor is not recommended for patients at low risk of gastrointestinal bleeding, who have much less potential to benefit from prophylactic therapy.[19] (Level of Evidence: C)"
Class IIa
"1. Use of proton pump inhibitors is reasonable in patients with an increased risk of gastrointestinal bleeding (e.g., advanced age, concomitant use of warfarin, steroids, nonsteroidal antiinflammatory drugs, Helicobacter pylori infection) who require dual antiplatelet therapy (DAPT).[19] (Level of Evidence: C)"

Post-Procedural Clopidogrel Genetic Testing (DO NOT EDIT)[2]

Class III (No Benefit)
"1. The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[20] (Level of Evidence: C)"
Class IIb
"1. Genetic testing might be considered to identify whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhibition with clopidogrel.[20] (Level of Evidence: C)"
"2. When a patient predisposed to inadequate platelet inhibition with clopidogrel is identified by genetic testing, treatment with an alternate P2Y12 inhibitor (e.g., prasugrel or ticagrelor) might be considered.[20] (Level of Evidence: C)"

Post-Procedural Platelet Function Testing (DO NOT EDIT)[2]

Class III (No Benefit)
"1. The routine clinical use of platelet function testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[20] (Level of Evidence: C)"
Class IIb
"1. Platelet function testing may be considered in patients at high risk for poor clinical outcomes.[20] (Level of Evidence: C)"
"2. In patients treated with clopidogrel with high platelet reactivity, alternative agents, such as prasugrel or ticagrelor, might be considered.[20] (Level of Evidence: C)"

Exercise Testing (DO NOT EDIT)[2]

Class III (No Benefit)
"1. Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed.[21](Level of Evidence: C)"
Class IIa
"1. In patients entering a formal cardiac rehabilitation program after PCI, treadmill exercise testing is reasonable. (Level of Evidence: C)"

Cardiac Rehabilitation (DO NOT EDIT)[2]

Class I
"1. Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (Level of Evidence: A)"

References

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