Heart Attack and Unstable Angina
Other Treatment
In the past decade, angioplasty, also known as percutaneous coronary intervention (PCI), has become a common procedure in large medical centres in Canada and the United States. Angioplasty is done during cardiac catheterization or coronary angiogram. However, some treatments such as angioplasty or cardiac catheterization may be available only at certain regional medical centres. The treatment your doctor chooses may depend on how close you are to a regional centre and the time it would take to transport you to the centre for treatment.24, 25
During a cardiac catheterization, a tiny tube (called a catheter) is threaded through an artery of an arm or leg up into the heart and a dye that contains iodine is then injected through the catheter. The dye makes the coronary arteries visible on a digital X-ray screen. The doctor can then see on a TV screen whether your coronary arteries are blocked and how your heart is beating. If an artery appears blocked, angioplasty with or without stent placement may be done during the catheterization to open the blockage.
Studies show that angioplasty with stent placement, compared with angioplasty only, reduces the chance that the artery will re-narrow and possibly reduces the risk of death.16 (See a picture of stent placement
). Angioplasty with stent placement is less invasive and expensive than bypass surgery and is the preferred treatment for most people with a heart attack.
In some cases a heart attack causes enough muscle damage that your heart's pumping capacity is decreased. In this case, your doctor may recommend placement of a type of pacemaker called an implantable cardioverter-defibrillator (ICD), especially if you have life-threatening abnormal heart rhythms.
What to Think About
Even with stents, an artery can re-narrow after angioplasty, although recent innovations are improving the long-term success of this procedure. Drug-eluting stents are coated with medicines that prevent the artery from re-narrowing. Experts do not know yet how safe the drug-eluting stents are over the long term or how well they work over the long term. Whether your doctor chooses to give you a drug-eluting stent will depend in part on whether you have any risk factors (such as diabetes) that make it more likely that your artery will narrow again, and whether your health would allow long-term dual antiplatelet therapy or another catheterization or coronary artery bypass graft surgery (CABG) at a later time, if needed.26
Although studies are not conclusive, folate therapy (taking a combination of folic acid, vitamin B6, and vitamin B12) may be harmful after stent placement and probably should be avoided.27 Instead, try to get enough vitamin B by eating a balanced diet.
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| Author: | Robin Parks, MS | Last Updated: February 26, 2008 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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