Percutaneous coronary intervention (PCI) is a minimally invasive procedure to treat coronary artery disease (CAD). CAD occurs when the coronary arteries are narrowed or blocked mainly due to the build-up of fatty plaque in the artery wall and creates obstruction in carrying the oxygen-rich blood to the heart and the rest of the body. Coronary artery disease also known as ischemic heart disease (IHD), is a leading cause of mortality worldwide. A report by the National Centre of Biotechnology Information (NCBI) has taken results from the Global Burden of Disease Study which states that “IHD affects around 126 million individuals (1,655 per 100,000), which is approximately 1.72% of the world’s population and the current prevalence rate of 1,655 per 100,000 population is expected to exceed 1,845 by the year 2030”.
Coronary artery disease: major risk factors
There are multiple risk factors for CAD. Some risks develop with poor lifestyle habits such as smoking, lack of physical exercise, unhealthy diet, stress, obesity, etc. while some are either genetic (family history) or due to aging. Out of all the risk factors, a family history of heart disease makes a person more vulnerable to coronary artery disease especially if a close family member like parents or siblings have developed heart disease at an early age. Unlike major issues like these, sometimes CAD can be developed without definitive risk factors like obstructive sleep disorder and other inflammatory conditions like rheumatoid arthritis. Coronary artery disease if not diagnosed early and not treated properly, over time, may lead to acute chest pain and shortness of breath. If the possible symptoms are observed, one should not delay consulting a doctor since it can debilitate the heart muscle which can even lead to heart failure.
Cardiac care: Then and now
The treatment of coronary heart disease has improved remarkably over the past decades in both the surgical and diagnosis side. Percutaneous coronary intervention (PCI) is the most advanced treatment procedure in the field of CAD that is being performed for decades now. Before the invention of PCI, coronary artery bypass grafting (CABG) was the only modality of coronary heart disease which had many complications like excessive bleeding during or after surgery, blood clots, and breathing issues, hence requiring prolonged hospitalization. However, with hardly any complications, PCI, the minimally invasive procedure is associated with reduced cardiovascular mortality in high-risk clinical scenarios such as unstable angina or acute coronary syndromes.
Role of advanced diagnostics/imaging technology for best PCI optimization outcomes
Today, interventional cardiologists can strategize the best treatment options depending on the patient’s condition. Thanks to the quality imaging modalities available today which are allowing doctors to customize the treatment strategy for patients. Since the inception of PCI, advanced imaging and diagnostic technologies have been continuously evolving that are ensuring safety and improved outcomes in the procedure. The advanced diagnostics of fractional flow reserve (FFR) helps evaluate the severity of the blockage in the arteries thus, helping the interventional cardiologist to decide whether PCI and stenting are needed. On the other hand, Optical Coherence Tomography (OCT) by using infrared light, produces a three-dimensional image that provides qualitative information about the damaged arteries, blood flow, or clotting and can guide accurate stent positioning hence, enhancing treatment outcomes.
Since, Coronary Artery disease tends to become more complicated with age, ensuring the accuracy of the treatment is of utmost priority that can be achieved only if we have better diagnostic tools to provide the required treatment to the patients. Today, even after the development of advanced technologies for PCI, coronary angiography (CAG) is still used as a gold standard to diagnose CAD and evaluate the treatment strategy. However, CAG has several limitations and is not as accurate as the latest options like FFR and OCT. Hence, embracing these high-end and futuristic technologies is very important to provide much improved clinical outcomes to patients suffering from CAD.
The author is the chairman of Interventional Cardiology, Heart Institute, Medanta, Gurugram. View are personal.