Therapy in Patients Undergoing Percutaneous Coronary Intervention

Background: Percutaneous coronary intervention (PCI) has become a cornerstone of coronary revascularization in patients with stable coronary artery disease and acute coronary syndromes (ACS). Advances in balloon angioplasty, bare-metal stents, drug-eluting stents, and adjunctive pharmacotherapy have substantially improved procedural success and reduced recurrent ischemic events. Nevertheless, periprocedural myocardial infarction, acute and late stent thrombosis, restenosis, bleeding, contrast-induced nephropathy, and medication nonadherence remain important determinants of morbidity and mortality. The introduction of drug-eluting stents and potent antithrombotic therapies has created new therapeutic challenges involving the balance between ischemic protection and hemorrhagic complications. Objectives: To critically evaluate pharmacotherapeutic strategies used before, during, and after PCI using evidence available through 2007; compare the efficacy and safety of antiplatelet, anticoagulant, and adjunctive cardiovascular medications; identify unresolved therapeutic controversies; and propose an integrated, pharmacist-directed framework for individualized therapy.