Talk:Percutaneous coronary intervention

Overlap with Angioplasty
PCI sounds like a subset of angioplasty. Not sure how much duplication of content is good. Rod57 (talk) 17:04, 8 September 2008 (UTC)

Explaining terms
"PTCA with stenting has been shown to be superior to angioplasty alone in patient outcome by keeping arteries patent for a longer period of time." Could do with an explanation of "patent" here Ricklaman (talk) 03:05, 17 March 2009 (UTC)

Possible Additions
Chicagolive (talk) 15:52, 10 July 2009 (UTC)
 * 1) Recent studies cast doubt on the usefulness of PCI in non-acute cases due to the demonstrated risks and unclear benefits as compared to straight medical therapy.[6] PCI is often reported to have marginal benefits with respect to angina pectoris, exercise performance, and quality of life.  Medical therapy performs better with respect to event-free survival (events are defined as additional revascularization, myocardial infarction or death).
 * 2) A heart attack during or shortly after the procedure occurs in 3% of cases; this may require emergency coronary artery bypass surgery. MY ADD→ "Heart muscle injury characterized by elevated levels of CK-MB, troponin I, and troponin T may occur in up to 30% of all PCI procedures. Elevated enzymes have been associated with later clinical outcomes such as higher risk of death, subsequent MI and need for repeat revascularization procedures."←    Angioplasty carried out shortly after a myocardial infarction has a risk of causing a stroke of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy.[citation needed]
 * 3) Add'n to risk of complications sub-sets
 * 4) *People with elevated levels of cardiac enzymes (CK-MB, troponin I, and troponin T) measured to be three times the baseline or above."←

Controversy
Is the treatment of angina relevant to this page? Introducing a new subject is confusing, and none of the statements are supported by journal articles. —Preceding unsigned comment added by 203.1.218.18 (talk) 08:57, 14 April 2011 (UTC) Treatment of chronic stable angina is relevant to the discussion but the information given in this section is incomplete misleading and inaccurate. The study referred to is the COURAGE trial which showed no benefit of PCI over medical treatment in chronic stable angina. The study however had a number of significant criticisms and smaller sub-studies showed benefit when ischaemia was demonstrated (the courage nuclear substudy) or when a lesion was confirmed as flow limiting using pressure wire measurements (FAME study). I am a cardiologist but not sure how to edit the page to quote these studies with references properly. — Preceding unsigned comment added by 109.246.186.92 (talk) 22:32, 14 May 2013 (UTC)

Primary percutaneous coronary intervention (PPCI)
I feel that Primary percutaneous coronary intervention (the treatment for STEMI which has replaced thrombolysis as the gold standard treatment) should be expanded as another section and the major papers/guidelines referenced. Feel free to discuss,  Captain n00dle \ Talk 15:34, 2 October 2011 (UTC)

I agree. Primary PCI should be expanded into a separate section. I'll start working on that in the near future. Your contributions are expected. --DocMeez (talk) 11:24, 18 August 2019 (UTC)

Merger proposal
I propose that angioplasty be merged with this article, though this could admittedly go either way as far as article titles go -- angioplasty seems more general, but that article is less well developed, as well as less frequently edited, so in contravention of the Merge guidelines i am posting the proposal here first, as the target article. (it is unclear to me whether angioplasty is in fact a synonym of PCI based on the literature but that is the impression this article gives.) it seems like the angioplasty article could be cleaned up and integrated here, making this article more informative overall. UseTheCommandLine (talk) 07:11, 22 August 2012 (UTC)


 * I agree. Nightscream (talk) 15:21, 13 September 2012 (UTC)

Onsite surgery
10.1161/CIR.0000000000000037 - American consensus document on the need for on-site cardiac surgery. JFW &#124; T@lk  10:12, 17 June 2014 (UTC)


 * And a meta-analysis: 10.1161/CIRCULATIONAHA.115.016137 JFW &#124; T@lk  08:46, 4 August 2015 (UTC)

For patients, edits
I have made some small edits to aid patients understand the article. The section about CABG, commonly known as a 'Heart Bypass' and in the section about adverse effects as a paragraph there was hard to understand.

This paragraph is added here at talk only for the benefit of patients, this procedure saves lives. I know from experience how fearful of the operation a patient can be, the heart attack is itself a frightening event. For the benefit of other patients reading this, the procedure works, it saves lives, to me this was not a painful procedure.

--Pennine rambler (talk) 03:50, 25 October 2014 (UTC)

Requested edits
I am an employee of Manifest, a marketing agency representing Abbott Vascular. I would like to request edits to this page as follows. If there are errors with citation format, please let me know and I will adjust. Thank you.

Paragraph 2 of intro: Delete the sentence beginning “At the blockage, the balloon is …” and replace with the following: Angioplasty usually involves inflating a balloon to open the artery and allow blood flow. Stents or scaffolds may be placed at the site of the blockage to hold the artery open. Current concepts recognize that after three months the artery has adapted and healed and no longer needs the stent,  which is the premise for developing stents that dissolve naturally after they are no longer necessary.

Paragraph 3 of intro: In the sentence that begins “Most studies have found…” delete “is better than PCI for reducing death and myocardial infarction” and replace with the following: offers advantages in reducing death and myocardial infarction in patients with multivessel blockages compared with PCI.

In the “Contents” section, move “Adverse events” to after “Usage” and renumber; under “Procedures” delete “3.1 Technique”, “3.2 Coronary stenting” and “3.3 Preventive angioplasty”; add a new topic/section “4 Types of stents used in PCI”

Delete the “Medical uses” section and replace with the following:

Medical Uses of PCI

PCI is used primarily to open a blocked coronary artery and restore arterial blood flow to heart tissue, without requiring open-heart surgery. In patients with a restricted or blocked coronary artery, PCI may be the best option to re-establish blood flow as well as prevent angina (chest pain), myocardial infarctions (heart attacks) and death. Today, PCI usually includes the insertion of stents, such as bare-metal stents, drug-eluting stents, and fully resorbable vascular scaffolds (or naturally dissolving stents). The use of stents has been shown to be important during the first three months after PCI; after that the artery can remain open on its own. This is the premise for developing bioresorbable stents that naturally dissolve after they are no longer needed.

The appropriateness of PCI use depends on many factors.

PCI may be appropriate for patients with stable coronary artery disease if they meet certain criteria, such as having any coronary stenosis greater than 50 percent or having angina symptoms that are unresponsive to medical therapy. Although PCI may not provide any greater help in preventing death or myocardial infarction over oral medication for patients with stable coronary artery disease, it likely provides better relief of angina.

In patients with acute coronary syndromes, PCI may be appropriate; however, guidelines and best practices are constantly evolving. In patients with severe blockages, such as ST-segment elevation myocardial infarction (STEMI), PCI can be critical to survival as it reduces deaths, myocardial infarctions and angina compared with oral medication. For patients with either non-ST-segment elevation myocardial infarction (nSTEMI) or unstable angina, treatment with medication and/or PCI depends on a patient's risk assessment.

Move the “Adverse events” section to after the “Usage” section

In the last paragraph of the “Adverse events” section, delete the sentence that begins “Less than 2% of people …” and replace with the following: The mortality rate during angioplasty is 1.2%.

In the heading for the “Procedures” section, delete the “s” so it is “Procedure”

In the “Procedures” section, suggest removing the entire paragraph that begins “Sometimes, a small mesh tube, or ‘stent’, is introduced into …” and ending with “thrombolytic (‘clot busting’) medication” as its content is covered elsewhere on the page.

Remove the subhead “Technique” since it is not needed; this is now under the section “Procedure” and the other subheads have been moved.

In number 8 under “Technique”, change the first part of the sentence to: If a stent was on the balloon, then it will be implanted (left behind) to support …

Change the subhead “Coronary stenting” to “Types of stents used in PCI” and replace all of the text in that section with the following:

Types of Stents Used in PCI

Traditional bare-metal stents (BMS) provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries.

Newer drug-eluting stents (DES) are traditional stents with a polymer coating containing drugs that prevent cell proliferation. The antiproliferative drugs are released slowly over time to help prevent tissue growth — which may come in response to the stent — that can block the artery. These types of stents have been shown to help prevent restenosis of the artery through physiological mechanisms that rely upon the suppression of tissue growth at the stent site and local modulation of the body’s inflammatory and immune responses. The first two drug-eluting stents to be utilized were the paclitaxel-eluting stent and the sirolimus-eluting stent, both of which have received approval from the U.S. Food and Drug Administration. Most current FDA-approved drug-eluting stents use sirolimus (also known as rapamycin), everolimus and zotarolimus. Biolimus A9-eluting stents, which utilize biodegradable polymers, are approved outside the U.S.

However, in 2006, clinical trials showed a possible connection between drug-eluting stents and an event known as “late stent thrombosis” where the blood clotting inside the stent can occur one or more years after stent implantation. Late stent thrombosis occurs in 0.9% of patients and is fatal in about one-third of cases when the thrombosis occurs. Increased attention to antiplatelet medication duration and new generation stents (such as everolimus-eluting stents) have dramatically reduced concerns about late stent thrombosis.

Newer-generation PCI technologies aim to reduce the risk of late stent thrombosis or other long-term adverse events. Some DES products market a biodegradable polymer coating with the belief that the permanent polymer coatings of DES contribute to long-term inflammation. Other strategies: A more recent study proposes that, in the case of population with diabetes mellitus — a population particularly at risk — a treatment with paclitaxel-eluting balloon followed by BMS may reduce the incidence of coronary restenosis or myocardial infarction compared with BMS administered alone.

Bioresorbable vascular scaffolds, or naturally dissolving stents, offer an alternative to permanent stents. The Absorb naturally dissolving stent is under study in the United States, but already available in Europe and other markets around the world. Absorb is made of a material similar to dissolvable stitches and is held open by the body's own blood pressure. Studies have shown that a stent is only needed for up to three months after PCI. Absorb naturally begins to dissolve in six to 12 months and is completely dissolved in two to three years (two small markers remain to indicate where the stent was placed). As the stent dissolves, the artery is free to respond naturally (dilate/constrict), like a normal blood vessel.

After placement of a stent or scaffold, the patient needs to take two antiplatelet medications (aspirin and one of a few other options) for several months to help prevent blood clots. The ideal length of time a patient needs to be on dual antiplatelet therapy is not fully determined, but recent studies support continuing beyond 12 months unless a patient is at a high risk for bleeding.

Delete the section “Preventive angioplasty” as this is now covered in the new “Medical Uses of PCI” section (see above)

In the “Usage” section, first sentence, delete PTCA and replace with “Percutaneous coronary angioplasty”

2601:500:4000:1745:41C9:D1C8:642D:8FB3 (talk) 21:20, 4 November 2015 (UTC)

Reply to edits requested above
I am replying to here because the section above is quite long and I hope this will minimize confusion. I believe the best approach would be to make those edits yourself, with the exception of the paragraph about the Absorb stent, which should be discussed separately after the other changes have been made. There are some issues with the changes, but it would be easier to resolve them by copy-editing rather than trying to get everything right beforehand. I will note a couple of things: (1) Per WP:MEDRS Wikipedia's medical articles should use review papers as sources rather than primary experimental studies, (2) when a reference is used more than once, it can be cited using the mechanism rather then typing out all the details each time it is used; see WP:REF for more information. Let's see what other participants at WPMED think. Looie496 (talk) 13:42, 12 December 2015 (UTC)
 * I agree w/ Louie496's recommendations above--Ozzie10aaaa (talk) 14:32, 12 December 2015 (UTC)
 * Thank you for this helpful feedback, Looie496 and Ozzie10aaaa. I'll proceed as you recommend. Tom at Manifest (talk) 22:01, 18 December 2015 (UTC)
 * Hello Looie496 and Ozzie10aaaa. I have incorporated my edits, with the exception of the recommended paragraph about the Absorb stent, which Looie496 recommended being discussed separately after the other changes were made. If you would please provide feedback on the Absorb stent paragraph, I'd greatly appreciate it. Please note, we changed some of the sourcing from my original post to rely more on review papers. Thank you for your help.Tom at Manifest (talk) 21:52, 13 January 2016 (UTC)
 * Marked the edit requests as answered, as they have been carried out. Altamel (talk) 01:39, 23 May 2016 (UTC)

STEMI guideline
10.1161/CIR.0000000000000336 JFW &#124; T@lk  16:28, 16 March 2016 (UTC)

Proposed merge with Angioplasty
These are synonyms of each other - shall propose target page be then renamed as angioplasty Iztwoz (talk) 11:45, 3 January 2017 (UTC)
 * Pages give conflicting info - a better move might be to rename PCI as specifically Coronary angioplasty and the angioplasty page would cover that in brief and other procedures such as for renal stenosis and veinous blockages.--Iztwoz (talk) 11:59, 3 January 2017 (UTC)


 * Oppose. Angioplasty is used for many other vascular beds (carotid, renal, peripheral artery, mesenteric). Current arrangement should stand. JFW &#124; T@lk  09:56, 10 January 2017 (UTC)
 * I would like to accept JFW's argument and withdraw merge proposal also for reasons given for page move withdrawal - better to expand coronary angioplasty on angioplasty page.--Iztwoz (talk) 11:11, 11 January 2017 (UTC)

Requested move 3 January 2017

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section. 

The result of the move request was: Withdrawn by nominator. --  Dane talk  03:49, 11 January 2017 (UTC)

Percutaneous coronary intervention → Coronary angioplasty – PCI hardly registers on ngrams. Most usage refers to angioplasty. Using its alternative name would lessen confusion (see talk pages) and would probably lend itself better for merging to Angioplasty as a subset. Iztwoz (talk) 12:26, 3 January 2017 (UTC)
 * I agree with the move to "coronary angioplasty", Agree with Jfd :-) I do not support the merge with angioplasty as that is a wide range of procedures of with the coronary type is simple one. Doc James  (talk · contribs · email) 13:33, 3 January 2017 (UTC)
 * Oppose. PCI is more than just angioplasty (think rotablation, thrombus aspiration, IVUS/OCT, pressure wire determination for FFR). There's enough for a subarticle on coronary angioplasty (choice of stent, when to do CABG instead). JFW &#124; T@lk  09:15, 10 January 2017 (UTC)
 * Should like to withdraw merge proposal - info was not previously clear but recent edits have made procedures clearer and i now agree with JFW's proposal.--Iztwoz (talk) 14:25, 10 January 2017 (UTC)


 * The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

The caption under the infobox's picture
I think it goes into too much details for a Wikipedia article, and for an infobox picture. It should say "A coronary angiogram showing the circulation in the left main coronary artery and its branches." The rest is more Radiopaedia than Wikipedia. —Hexafluoride Ping me if you need help, or post on my talk 20:00, 22 January 2017 (UTC)


 * sofixit I mean, WP:BOLD. JFW &#124; T@lk  21:16, 22 January 2017 (UTC)

Length of stent
This was added: The length of the stent implanted was proposed as a risk factor for the development of stent thrombosis. However recent trials have shown acceptably lower adverse outcomes with the use of long stents.

10.1016/j.ihj.2018.05.016 is a primary source so not good for encyclopedia content. JFW &#124; T@lk  12:04, 3 June 2018 (UTC)

A number of articles that are really interlinked.
Three articles that are closely interlinked -

Percutaneous coronary intervention

Drug-eluting stent

Coronary stent

I suspect there a several others that overlap - I think the fact PCI is discussed in all three at depth - is not a really bad thing, and historically authors have always expanded them to include a lot of common materials - I think this is likely fine. More observational at this point.

I do note a lot of casual edits - that might miss the point that data exists that repeats though all articles are wikilinked.

As PCI is fundamental to stent placement (any kind of stent) in any part of the arterial system - there would always be some mention of the procedure.

Respectfully. Dr. BeingObjective (talk) 19:39, 21 November 2023 (UTC)


 * Did a fair amount of reorganizing - the procedure description section seemed rather old and did not really reflect the fact that PCI medical devices are a fully integrated systems - as of 2023 - of guidewire/catheter/balloon etc. More images and video would help in this article - Dr. BeingObjective (talk) 15:49, 23 November 2023 (UTC)