Clinical Subject Page
Percutaneous Coronary Intervention (PCI)
Also called
Coronary Angioplasty
ICD-10
02703ZZ
Specialty
Cardiology
Onset
For Acute & Chronic Conditions
Reviewed
July 2026
On This Page
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OverviewOverview
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IndicationsIndications
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ContraindicationsContraindications
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Pre-Procedure AssessmentPre-Procedure Assessment
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PCI Procedure (Step-by-step)PCI Procedure (Step-by-step)
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Types of Stents & DevicesTypes of Stents & Devices
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Post-PCI CarePost-PCI Care
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ComplicationsComplications
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PrognosisPrognosis
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Key Points / Clinical PearlsKey Points / Clinical Pearls
Overview
Percutaneous coronary intervention (PCI) is a minimally invasive catheter-based procedure used to restore coronary blood flow by balloon angioplasty with or without stent implantation.
Teaching point
Acute: Primary PCI for STEMI, high-risk NSTEMI, unstable angina.
Chronic: Elective PCI for chronic coronary syndrome (stable CAD).
Indications
- Acute STEMI (primary PCI)
- High-risk NSTEMI/Unstable angina
- Symptomatic chronic coronary syndrome despite optimal medical therapy
- Significant coronary artery stenosis causing ischemia
- Cardiogenic shock due to acute MI
- In-stent restenosis
- Selected patients with multivessel coronary artery disease
Contraindications
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Absolute
- No absolute contraindications in life-saving primary PCI
Relative
- Severe contrast allergy
- Advanced renal failure
- Uncontrolled bleeding disorder
- Inability to receive dual antiplatelet therapy
- Severe uncontrolled hypertension
- Active infection (selected cases)
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Pre-Procedure Assessment
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Clinical Assessment
- History and physical examination
- Hemodynamic stability
- ECG
- Cardiac biomarkers
Laboratory
- CBC
- Renal function
- Electrolytes
- Coagulation profile
- Blood glucose
Imaging
- Coronary angiography
- Echocardiography (if indicated)
Preparation
- Informed consent
- Aspirin loading
- P2Y12 inhibitor loading
- Anticoagulation
- Assess contrast allergy and kidney function
Important Note
Primary PCI is the gold-standard treatment for STEMI, and adherence to dual antiplatelet therapy after stent placement is critical.
PCI Procedure (Step-by-Step)
- Obtain vascular access (radial preferred; femoral if required)
- Advance catheter to the coronary arteries
- Perform coronary angiography
- Cross the lesion with a guidewire
- Balloon angioplasty (predilation if needed)
- Deploy coronary stent
- Post-dilation (if necessary)
- Confirm adequate coronary flow (TIMI 3 flow)
- Remove catheter and achieve hemostasis
Types of Stents & Devices
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Stents
- Drug-eluting stent (DES) (preferred)
- Bare-metal stent (BMS) (rarely used)
Other Devices
- Balloon catheter
- Guidewire
- Guiding catheter
- Intravascular ultrasound (IVUS)
- Optical coherence tomography (OCT)
- Rotational atherectomy
- Intravascular lithotripsy (selected calcified lesions)
Post-PCI Care
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- Continuous ECG monitoring
- Monitor vascular access site
- Dual antiplatelet therapy (Aspirin + P2Y12 inhibitor)
- High-intensity statin
- Risk-factor modification
- Cardiac rehabilitation
- Early ambulation (radial access)
- Follow-up for recurrent symptoms
Complications
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- Coronary artery dissection
- Coronary perforation
- Acute stent thrombosis
- Restenosis
- Bleeding or hematoma
- Contrast-induced nephropathy
- Stroke
- Arrhythmias
- Myocardial infarction
- Death (rare)
Prognosis
- Excellent procedural success (>95% in experienced centers)
- Primary PCI significantly reduces mortality in STEMI.
- Drug-eluting stents have lower restenosis rates than bare-metal stents.
- Long-term outcomes depend on adherence to medical therapy and risk-factor control.
Key Points / Clinical Pearls
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- Primary PCI is the treatment of choice for STEMI.
- Radial artery access is preferred because it reduces bleeding complications.
- Drug-eluting stents are the standard of care.
- Dual antiplatelet therapy is essential after stent implantation.
- TIMI grade 3 flow indicates successful reperfusion.
- Secondary prevention (statins, BP control, smoking cessation, cardiac rehabilitation) is crucial for long-term success.