Percutaneous Coronary Intervention

Key points

• PCI restores myocardial perfusion in stable angina and ACS; stents are implanted in ~95% of patients (balloon angioplasty alone is now rare).
• Stent thrombosis: 1–2% of patients, most commonly in the first month, usually presents with acute MI (platelet aggregation before stent endothelialisation).
• Restenosis: 5–20% of patients, most commonly in the first 3–6 months, presents with recurrent angina; risk factors = diabetes, renal impairment, stents in venous bypass grafts.
• Drug-eluting stents (paclitaxel/rapamycin) reduce restenosis but increase thrombosis (slower endothelialisation) → require a LONGER duration of clopidogrel than bare-metal stents.
• Aspirin is continued indefinitely after stenting; clopidogrel length depends on stent type, reason for insertion and consultant preference.

Decision points in this pathway

• Recurrent cardiac symptoms after stenting?
• Acute myocardial infarction presentation (typically within the first month)?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.