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Percutaneous coronary intervention is a catheter-based revascularization procedure used to open narrowed or occluded coronary arteries using balloon angioplasty and usually stent implantation to restore myocardial blood flow.

Major indications include STEMI, high-risk NSTEMI or unstable angina, refractory angina despite optimal medical therapy, and selected cases of stable ischemic heart disease with significant coronary stenosis.

Primary PCI achieves higher rates of complete reperfusion, reduces reinfarction and intracranial hemorrhage, and improves survival when performed within guideline-recommended time limits.

Primary PCI should be performed within 90 minutes of first medical contact at a PCI-capable center, or within 120 minutes if transfer from a non-PCI center is required.

No-reflow is failure of adequate myocardial perfusion despite successful opening of the epicardial coronary artery, usually due to microvascular obstruction from distal embolization or ischemia–reperfusion injury.

Radial access significantly reduces bleeding and vascular complications, allows early ambulation, improves patient comfort, and is associated with lower mortality in high-risk ACS patients.

Contrast-induced nephropathy is an acute decline in renal function occurring within 48–72 hours after contrast exposure, especially in patients with chronic kidney disease, diabetes, or dehydration.

Drug-eluting stents release antiproliferative drugs that inhibit neointimal hyperplasia, markedly reducing the risk of in-stent restenosis compared to bare-metal stents.

DAPT consists of aspirin plus a P2Y12 inhibitor and is essential to prevent acute and late stent thrombosis after PCI, particularly following drug-eluting stent implantation.

In acute coronary syndrome, DAPT is recommended for at least 12 months unless bleeding risk is high; shorter durations may be considered in selected stable patients.

Stent thrombosis is acute occlusion of a coronary stent by thrombus formation and is a life-threatening complication associated with sudden myocardial infarction, arrhythmias, and high mortality.

Patients with diabetes, multivessel coronary artery disease, high SYNTAX score, or left ventricular dysfunction often have better long-term survival with CABG compared to PCI.

TIMI flow grading assesses the degree of coronary blood flow after reperfusion, with TIMI grade III indicating normal flow and optimal procedural success.

Complications include bleeding, vascular injury, contrast-induced nephropathy, no-reflow phenomenon, coronary dissection or perforation, stent thrombosis, and arrhythmias.

PCI improves survival in cardiogenic shock by restoring coronary perfusion, with current guidelines recommending culprit-lesion-only PCI during the acute phase.