Cardiovascular Critical Care I

Post-Intervention Complications

Bleeding (particularly retroperitoneal bleeding)

Several antithrombotic agents are used during PCI to inhibit both the platelets and the clotting

cascade, causing potential coagulopathies.

In addition to antithrombotic use, the catheterization access site has been identified as a major

contributor to post-PCI bleeding complications.

also be caused by vessel trauma from the catheter itself.

Stent thrombosis

When antiplatelet therapy is discontinued early (aspirin, P2Y12 inhibitor, or both), stent thrombosis

may occur in up to 25% of coronary artery stents, irrespective of type of stent (drug-eluting stent

or bare metal stent).

Almost 1 in 7 patients may discontinue P2Y12 inhibitors within 30 days post-PCI, thus increasing

2013;310:189-98).

Mortality rates associated with stent thrombosis can be as high as 45%.

these risks with the risk of stent thrombosis.

late after the initial insult occurs, resulting in extensive myocardial damage:

Free wall rupture (most often a fatal complication)

Dressler syndrome pericardial effusion

Post-MI ventricular septal defect (associated with up to 50% mortality; repair must be delayed for

optimal outcomes because the tissue is too friable to repair)

LV aneurysm

Arrhythmias (particularly after reperfusion)

management

Medications that should be initiated before discharge or contraindications should be documented in the

medical record:

Aspirin

Statin (high intensity)

P2Y12 inhibitor

If LVEF less than or equal to 40%

ACE inhibitor or ARB or angiotensin receptor/neprilysin inhibitor

ii.

Aldosterone antagonist (if also evidence of HF and/or diabetes)

iii.

Sodium glucose co-transporter 2 inhibitor (if patient has other compelling indications such as

diabetes or chronic kidney disease)

LV function assessment (by imaging or during catheterization)

Cardiac rehabilitation

Smoking cessation counseling

preferably be obtained within 24 hours of admission. Any lipid profile measured between 6 months

before first medical contact and hospital discharge qualifies for this quality measure.

For more information on cardiology-related quality measures and registries, see www.ncdr.com.