Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention, or PCI, is a "minimally invasive" procedure. PCI procedures include balloon angioplasty and coronary artery stenting.

PCI is used as a treatment option for Coronary Artery Disease (CAD). Depending on your medical history or the condition of your blocked artery, a Coronary Artery Bypass Surgery (CABG) may be advised by your doctor.

A small balloon is inflated within the narrowed portion of a blocked artery, pushing plaque against the artery walls and improving blood flow to the heart.

A metallic coronary artery stent is permanently implanted in the blocked artery.

In preparation for your procedure, your doctor will provide you with specific instructions such as fasting (no food or drink) on the day of the procedure. Your doctor will also ask you about:

• Medications you are currently taking.
• Medications you cannot take or may have an allergy to.
• Any history of bleeding problems.
• Any metal allergies.
• Any surgery or dental work you may be due to have soon.
• If you are a female, your doctor may also want to know whether you are currently pregnant, nursing a child or planning to get pregnant.

Some routine investigations, including blood tests, an Electrocardiogram (ECG) and a chest X-ray may be done before the procedure. You will usually be required to fast 6-8 hours before the procedure.

• On the morning of your test, you will be asked to empty your bladder and shave hair from your groin. You will be placed on a movable table, with X-ray cameras and LCD monitors around you. A nurse will clean your groin and wrist and then drape you with sterile towels. After an injection of a local anesthetic, a plastic tube called a sheath is inserted in an artery in the groin or wrist. Through this sheath, another long and narrow tube (catheter) is advanced to the origin of the coronary artery. A coronary angiogram is done first to provide a "road map" for the PCI, if necessary.

• In PCI, a fine wire is then threaded through the catheter and advanced into the coronary artery across the narrowed segment. This wire serves as a rail over which the balloon catheter is finally delivered and positioned over the area of narrowing for focused angioplasty to open the narrowed segment.

• The procedure is usually followed by another procedure called stenting where a small metal or polymer coil is placed to serve as scaffold. The procedure may take from 1/2 to 2 hours, depending on the complexity of the diseased artery.

- Your doctor will use a special X-ray machine to see the scaffold or stent in your artery and to assess how well the artery has been opened up.

- Once blood flow is restored, the balloon is removed.

- The stent or scaffold is left behind, and may slowly release medication to treat the diseased area.

Overall, the procedure is very safe and well tolerated. In general, major complications such as heart attack, abnormal heart rhythm, stroke, trauma to the blood vessels, major bleeding, drug allergy, need for emergency surgery, and death, occur in less than 1% of patients undergoing PCI. This risk is dependent on the complexity of coronary narrowing and the patient's underlying medical conditions and may therefore be higher if the patient has comorbid conditions, eg. dvanced age, kidney failure, weak heart function.

Other less serious complications occur in 1-3% and include bleeding from the puncture site, bruising and swelling of the puncture site, and blood cloth formation in the artery where the sheath is inserted.

The other risks are those that pertain to local anaesthesia, sedation, and blood transfusion. Conscious sedation and local anaesthesia are generally applied to alleviate anxiety and procedure discomfort.

Following successful balloon angioplasty or stent implantation, there is still a possibility that narrowing of the heart artery may recur. This may occur either in the same area, a different segment, or a different artery. This is more likely with extensive coronary artery disease and inadequate control of risk factors.

It is therefore important for you to be compliant to the lifestyle changes, prescribed medications, and return regularly for medical reviews with your doctor.

1. Rest in bed for 4 hours after your procedure
2. Allow your nurse to access your wound 4 hours later
3. Change your postion - ONLY after your nurse determines it is safe to do so

How to change your position?*

• SIT - sitting on the edge of bed or chair
• STAND - stretch and get out of bed
• WALK - take a few steps {e.g. around the room)

*Change of position should be done under nurses' supervision. Kindly approach your nurse for more information if you have any doubts.

Start your stop smoking plan with STOP

S; Set a date for stopping and stop completely

T; Tell your family, friends, and co-workers that you plan to quit. Family and friends often provide support and may help you.

O; Optimistic - be positive and believe in yourself that you will be able to overcome the difficulties.

P; Prepare - throw away all your cigarettes, vapes, lighters and ashtrays. Wash your clothes and freshen up anything that smells like smoke. Be prepared for withdrawal symptoms and how to overcome them.

Speak to your healthcare provider for a referral to the Smoking Cessation Clinic or call 6908 2222 for an appointment.

Activities

• Refrain from physical exertions like heavy housework.
• Avoid heavy lifting until you recover.
• Take short walks or strolls depending on your physical condition.
• If you feel well after 2 weeks, gradually increase your usual activities, but stop if you feel unwell, and to inform your doctor.
• You are highly encouraged to join a cardiac rehabilitation programme to regain your confidence and ensure safe return to physical activities.

Driving

• It is recommended to avoid driving according to your doctor's advice (depending on one's condition).
• If you are presently admitted for a heart attack, it is best to avoid driving for a month.

Going back to work

• It will depend on your progress. Seek the advice of your doctor.

Medication

• Take your medications are prescribed. You should not stop your medication without consulting your doctor.

Sex

• This depends on the individual but generally you can resume your normal sexual activity 4 weeks after your procedure, only if you feel good and well rested.

Travel

• Avoid aircraft travel for 1 month or as per doctor's advice depending on one's condition.

Wound care

• If the insertion site is increasingly painful, swollen, red, bleeding, or the bruise is increasing in size, seek medical help or proceed to the Accident & Emergency (A&E).