Interventional cardiology is the specialized branch of cardiology that treats coronary artery disease with balloon angioplasty and stenting, therapies that unblock clogged arteries that supply blood to the heart, stop heart attacks and relieve angina, or chest pain. To perform angioplasty, doctors, called interventional cardiologists, must have extra training to learn how to thread a small, flexible tube, or catheter, with an uninfected balloon on its tip, from an artery in the groin to the blockage. At the blockage, they inflate the balloon to push open the blockage and restore blood flow through the artery. They may also guide a stent, a tiny mesh tube, to the point of the blockage to “prop open” the artery.

Percutaneous Coronary Intervention, or PCI, refers to coronary angioplasty and other interventions, such as stenting, in which interventional cardiologists perform therapeutic medical procedures within the arteries. PCI is less invasive than open heart surgeries, such as cardiac bypass surgery (CABG).

It is not possible to generalize about who should or shouldn’t undergo PCI, except in the case of patients experiencing a heart attack. If a heart attack is under way, PCI or cardiac bypass surgery are immediately considered as treatments to restore blood flow to the heart. For patients with stable (as opposed to acute) coronary artery disease, decisions about treatment options are based on patient medical history, current health status and how satisfied – or dissatisfied – the patient is about the limitations the disease imposes on his or her desired lifestyle.

Medical, or drug, therapy is the first line of treatment for patients with stable coronary artery disease. These patients have continuing symptoms that remain consistent and, as a result, become predictable. For example, a stable coronary artery disease patient would know that carrying the groceries or walking up a particular hill on the golf course will leave him or her short of breath. For some of these patients, drug therapy may be the most effective treatment, depending on health history, current health status, lifestyle expectations (such as the desire to participate in physical activities without chest pain or shortness of breath) and tolerance of and compliance with prescribed medications. PCI may be a more effective, long-term treatment for patients who find that the medications are poorly tolerated or do not treat their symptoms. Some patients also develop “unstable symptoms,” such as a more frequent chest pressure or pressure at rest from their coronary artery disease. Cardiologists often recommend PCI for these patients.

Evidence is unequivocal that PCI is the best therapy for patients who are having large heart attacks characterized by specific electrocardiogram (ECG) changes. However, hardening of the arteries (atherosclerosis) is a generalized disease that affects every blood vessel in the heart. Therefore, treatment of one blockage in a single artery at one instant in time does not prevent other blockages in other arteries at other times. To prevent future heart attacks, it is vital that patients with coronary artery disease take a strict regimen of medications designed for that purpose.