The prevention and management of complications during percutaneous coronary intervention

Summary

Percutaneous Coronary Intervention (PCI) is a potentially hazardous enterprise with attendant risks and benefits. It has the ability to relieve symptoms in chronic ischaemic heart disease and alter the natural history of acute coronary syndromes. Adverse procedural outcomes, however, as a direct result of the intervention itself, can occur. These outcomes, otherwise known as complications, are well described. Complications beget complications and despite the application of best management practices frequently result in an unsatisfactory clinical result. A premium therefore exists for preventing their development in the first place. Despite this, a paucity of systematic data exists on the root causes of suboptimal PCI performance. When compared to other professions that operate within high-risk environments using complex technology, the approach to the study and prevention of complications in interventional cardiology is underdeveloped. Knowledge of patient and lesion variables has helped to predict groups at risk but the influence of human error and system failure are not well recognised. New ways of thinking, based on principles used in other safety critical environments with very low adverse outcomes, may be required to reduce complication rates. As access to PCI extends to ever more challenging patient and disease groups together with a proliferation...