Routine management after percutaneous coronary intervention

Following a technically successful procedure, it is the post-procedural care of the patient that will often dictate both short- and long-term outcomes. Post-procedural care involves close monitoring of the patient for early complications, which may be secondary to the procedure itself or the presenting complaint. Immediate complications following percutaneous coronary intervention (PCI) may occur due to bleeding, most commonly at the access site, or due to early cardiac complications, often related to technical issues during the procedure. Non-cardiac complications, such as the development of contrast nephropathy, will become apparent in the hours or days following the initial procedure. Prompt and accurate identification of post-procedural complications is essential if they are to be managed effectively, and identification of the ‘at risk’ patient may also facilitate early identification of problems when they do occur. Complication rates are higher in patients with acute coronary syndromes, often exacerbated by aggressive antithrombotic regimens, and also in older patients with comorbid conditions. The type of care and length of stay will also vary according to the clinical context and needs to be carefully considered once the PCI has been performed. Following discharge, the longer-term management of residual coronary disease and recurrent ischaemia along with appropriate secondary prevention may all affect longer-term outcome. This chapter will examine the issues surrounding the immediate and longer-term care of the patient following PCI.