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STATE-OF-THE-ART PAPER

Percutaneous Coronary Intervention for Stable Coronary Artery Disease

Demosthenes G. Katritsis, MD, PhD^_*,_* and Bernhard Meier, MD

^_* Departments of Cardiology, Athens Euroclinic, Athens, Greece
University Hospital Bern, Bern, Switzerland

Manuscript received March 12, 2008; revised manuscript received May 2, 2008, accepted May 26, 2008.

^_* Reprint requests and correspondence: Dr. Demosthenes G. Katritsis, Department of Cardiology, Athens Euroclinic, 9 Athanassiadou Street, Athens, Attica 11521, Greece (Email: dkatritsis{at}euroclinic.gr).

Patients with significant coronary artery stenoses are at increased risk of future cardiac events. However, in the absence of acute coronary syndrome or recent myocardial infarction and residual ischemia, elective percutaneous coronary intervention has not been shown to improve prognosis. Possible explanations for this might be the limited follow-up time adopted by most randomized trials comparing percutaneous coronary intervention with medical therapy, limited number of patients with proven ischemia enrolled in these trials, and adoption of complex, elaborate techniques that have not proved their usefulness. Published evidence identifies certain indications for percutaneous coronary intervention in patients with stable coronary lesions: demonstration of significant inducible ischemia, particularly in the context of a recent myocardial infarction; detection of unequivocally reduced fractional flow reserve; and specific angiographic features of coronary stenoses. Operators should take into account long-term consequences of adopted techniques rather than immediate angiographic results. We review existing evidence and provide our recommendations in this setting.

Key Words: angioplasty • ischemic heart disease • coronary intervention

Abbreviations and Acronyms   MI = myocardial infarction   PCI = percutaneous coronary intervention

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