Unifying Concepts

Clinical Indications and Contraindications to Percutaneous Coronary Intervention (PCI)

Percutaneous coronary interventions (PCI) include percutaneous transluminal coronary angioplasty (PTCA) with or without stenting. Primary indications are treatment of angina pectoris (stable or unstable), myocardial ischemia, and acute MI (particularly in patients with developing or established cardiogenic shock).

Clinical Indications and Contraindications to PCI

  • Acute ST elevation myocardial infarction (STEMI)
  • Non ST elevation acute coronary syndrome
  • Stable angina
  • Anginal equivalent (eg, dyspnea, arrhythmia, dizziness/syncope)
  • Asymptomatic or mildly symptomatic patients with objective evidence of a moderate to large area of viable myocardium or moderate to severe ischemia on noninvasive testing


  • Significant comorbidities (relative contraindication)

Angiographic Indications and Contraindications to PCI

  • Hemodynamically significant lesion in a vessel serving viable myocardium (vessel diameter >1.5 mm)

Relative contraindications

  • Left main stenosis in a patient who is a surgical candidate
  • Diffusely diseased small-caliber artery or vein graft
  • Other coronary anatomy not amenable to percutaneous intervention



  1. Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1;120(22):2271-306. [Medline]
  2. Anderson HV, Shaw RE, Brindis RG, Klein LW, McKay CR, Kutcher MA, Krone RJ, Wolk MJ, Smith SC Jr, Weintraub WS. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force Guidelines. Circulation. 2005 Nov 1;112(18):2786-91. [Medline]


Created: Feb 18, 2011.

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