Management of Patients Undergoing Percutaneous Coronary Revascularization

Management of Patients Undergoing Percutaneous Coronary Revascularization

Glenn N. Levine, MD;
Morton J. Kern, MD;
Peter B. Berger, MD;
David L. Brown, MD;
Lloyd W. Klein, MD;
Dean J. Kereiakes, MD;
Timothy A. Sanborn, MD;
Alice K. Jacobs, MD; and
for the American Heart Association Diagnostic and Interventional Catheterization Committee and Council on Clinical Cardiology

From Baylor College of Medicine, Houston, Texas; St. Louis University, St. Louis, Missouri; Mayo Clinic, Rochester, Minnesota; Beth Israel Medical Center, New York, New York; Rush Medical College, Chicago, Illinois; The Lindner Research Center and Ohio Heart Health Center, Cincinnati, Ohio; Evanston Northwestern Healthcare, Evanston, Illinois; and Boston University School of Medicine, Boston, Massachusetts.

Abstract

While performance of percutaneous coronary intervention (PCI) remains the domain of specialized cardiologists, patients undergoing PCI are cared for by noninvasive cardiologists, internists, and primary care physicians. Therefore, patient care is optimized when the entire patient care team understands procedural risks and complications as well as optimum patient management before, during, and after PCI.

Before PCI, patients with contrast dye allergies should be identified and pretreated with steroids and an H₁-blocker. Hydration should be initiated and maintained before and after the procedure to minimize the risks for contrast nephropathy. Periprocedure, patients should be monitored clinically for evidence of ischemia. In patients with significant groin, flank, abdominal, or back pain, as well as those with decrease in hematocrit or unexplained hypotension, the diagnosis of groin or retroperitoneal hematoma should be considered and promptly evaluated. Groin tenderness, pulsatile mass, or bruit should prompt evaluation for possible femoral pseudoaneurysm or arteriovenous fistulae. After the procedure, all patients treated with coronary stents should receive aspirin plus clopidogrel. Patients who develop typical anginal symptoms between the 1st and 6th to 8th months after PCI are likely to have restenosis and can be evaluated by an imaging study or repeated catheterization.

Article and Author Information

Potential Financial Conflicts of Interest:Consultancies: G.N. Levine (Aventis, Schering-Plough, Merck, Pfizer, The Medicines Company), P.B. Berger (BMS/Sanofi, Aventis), T.A. Sanborn (Davax, Boston Scientific, Genvac, Ethicon); Honoraria: G.N. Levine (Aventis, Schering-Plough, Merck, Pfizer, The Medicines Company), P.B. Berger (BMS/Sanofi, Aventis); Grants received: P.B. Berger (BMS/Sanofi, Merck, Cordis Millennium), T.A. Sanborn (X-SITE Medical).
Requests for Single Reprints: Glenn N. Levine, MD, Section of Cardiology 3C-330, Houston Veterans Affairs Medical Center (111-B), 2002 Holcombe Boulevard, Houston, TX 77030; e-mail, glevine{at}bcm.tmc.edu.
Current Author Addresses: Dr. Levine: Section of Cardiology 3C-330, Houston Veterans Affairs Medical Center (111-B), 2002 Holcombe Boulevard, Houston, TX 77030.
Dr. Kern: St. Louis University, 3635 Vista Avenue, St. Louis, MO 63110.
Dr. Berger: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr. Brown: Beth Israel Medical Center, 16th Street at First Avenue, New York, NY 10003.
Dr. Klein: Rush Heart Institute, 1653 West Congress, Chicago, IL 60612.
Dr. Kereiakes: Lindner Research Center, Ohio Heart Health Center, Suite 424, 2123 Auburn Avenue, Cincinnati, OH 45219.
Dr. Sanborn: Evanston Northwestern Healthcare, 2550 Ridge Avenue, Evanston, IL 60201.
Dr. Jacobs: Boston Medical Center, 88 East Newton Street, Boston, MA 02118.