The importance of percutaneous coronary intervention (PCI) as an integrated intervention for persistent coronary occlusion after myocardial infarction seems to have little indication of any improvements or positive benefits in the long term. When integrated with optimal medical therapy and stent placement there is little indication that in deed PCI affords the patients a higher chance of regression of coronary atherosclerosis (Hochman et al., 2006). In this regard, optimal medical therapy alone indicated significant benefits with particular reference to significant regression of coronary atherosclerosis for any period past the three years upon initiation of PCI. This in some sense indicates that while PCI is associated with remodeling, provision of collaterals as well as elevated electrical stability for patients who experience acute myocardical infarction, these benefits are not actually consistent across all patient groups (Mehran et al., 2011).
In fact, even where these benefits may appear, there is enough belief to argue that they occur due to any other patient-related factors and not primarily due to the integration of PCI. A pertinent question that comes to the fore at this point and in relation to this idea that PCI benefits in patients with infarct-related coronary artery are statistically insignificant is whether it would be more important to focus on lifestyle and diet changes as the more viable strategies for the prevention of subsequent events in this category of patients. The lifestyle and dietary changes indicate better long term benefits with particular indication that subsequent events such as progression of coronary atherosclerosis are less likely to manifest (Hochman et al., 2006).
With the importance of PCI seemingly declining, the focus should now be on developing patient-specific comprehensive lifestyle changes. These lifestyle changes have indicated minimal side effects as compared to the PCI or the integrated elements of PCI such as stents which have been associated with higher future risk of developing late thrombosis especially where drug eluting stents are applied in the optimal medical therapy. Lifestyle changes and optimal medical therapy may be the solution to prevention of subsequent events in the long term (Mehran et al., 2011).
References
Hochman, J. S., Lamas, G. A., Buller, C. E., Dzavik, V., Reynolds, H. R., Abramsky, S. J., & Sadowski, Z. (2006). Coronary intervention for persistent occlusion after myocardial infarction. New England Journal of Medicine, 355(23), 2395-2407.
Mehran, R., Claessen, B. E., Godino, C., Dangas, G. D., Obunai, K., Kanwal, S., & Park, S. J. (2011). Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC: Cardiovascular Interventions, 4(9), 952-961.
