Items in FPM with MESH term: Angioplasty, Transluminal, Percutaneous Coronary
Prognosis for Patients Undergoing Coronary Angioplasty - Point-of-Care Guides
Estimating the Risks of Coronary Angioplasty - Improving Patient Care
ABSTRACT: In the guideline developed by the American College of Cardiology and the American Heart Association, the management of suspected unstable angina and non–ST-segment elevation myocardial infarction (UA/NSTEMI) has four components: initial evaluation and management; hospital care; coronary revascularization; and hospital discharge and post-hospital care. Part II of this two-part article discusses coronary revascularization, hospital discharge, and post-hospital care. Decisions must be made about the use of coronary angiography and coronary revascularization in patients hospitalized with UA/NSTEMI. With an early conservative strategy, medical management is employed. Coronary angiography and revascularization are reserved for use in patients with evidence of ischemia at rest (or with minimal activity) and patients with a strongly positive stress test. With an early invasive strategy, coronary angiography and revascularization are recommended within 48 hours in patients without contraindications. Hospital discharge planning involves coordination of medical care, preparation of the patient for resumption of normal activities, and evaluation of the need for long-term risk factor reduction. Discharge medications should be continued to control ongoing symptoms (anti-ischemic agents) and prevent recurrent events (aspirin, clopidogrel, beta blocker, and an angiotensin-converting enzyme inhibitor or statins in selected patients).
Drug-Eluting Coronary Artery Stents - Article
ABSTRACT: Many advances have been made in the percutaneous treatment of coronary artery disease during the past 30 years. Although balloon angioplasty alone is still performed, the use of coronary artery stents is much more common. Approximately 40 percent of patients treated with balloon angioplasty developed restenosis, and this was reduced to roughly 30 percent with the use of bare-metal stents. However, restenosis within the stent can occur and is difficult to treat. Drug-eluting stents were developed to lower the rate of restenosis, which now occurs in less than 10 percent of patients treated with these stents. There have been concerns about abrupt thrombosis within drug-eluting stents occurring late after their implantation, leading to acute myocardial infarction and death. Recent studies have alleviated, but not completely dispelled, these concerns. Strict adherence to dual antiplatelet therapy with aspirin and a thienopyridine is required after stent placement, and the premature discontinuation of therapy is the most important risk factor for acute stent thrombosis. Adequate communication between cardiologists and primary care physicians is essential not only to avoid the premature discontinuation of therapy, but also to identify, before stent placement, those patients in whom prolonged antiplatelet therapy may be ill-advised. Elective surgery following stent placement should be delayed until the recommended course of dual antiplatelet therapy has been completed.