What is PCI?

What are the dental

considerations in
patients with PCI done?

What are the concerns?

 What are the
Patient had concerns?
history of
• Possibly post-MI
PCI
recently
• Bleeding risk
Patient had history of PCI
What should you ask?
• WHY is PCI done?
• Post-MI?
• Preventive for UA or stable CAD?

• WHEN was it done?

• Many many months or years ago?
• Or just weeks or even days ago?
Over the decades
The number of patients with general diseases requiring dental
treatment is on the increase.

Advancement of cardiac management in the last 2 decades that lead

to modification in our patient management

There is more widespread of access to the invasive methods of

treatments of infarction, allowing the immediate reperfusion of
tissues.
 Post-MI PCI  x4/12 ago
To treat or not to treat?
Medical consideration Dental consideration
Post-MI x4/12 ago Pain & Inflammation from dental origin
What are the concerns?
Risk of re-infarction Source of endogenous catecholamines 
burden the already damaged heart muscles

Dental pain highly mimic angina pectoris,

interferes sleep, hinders food intake
 Former AHA guidelines suggest to avoid dental
surgery for 6 months
As the risk of complications was considered the
highest in this period

What does the old guideline say?

 The current evidence is…

Depends on patients’ types of therapy done:

• The most burdened group of patients are those treated conservatively

• currently only a small number, due to the pressure of cardiac society guidelines pertaining
to early invasive treatment

Once patient received PCI,

• Natural course of the disease lasts for more than 6 weeks

• This is the period needed for a post-infarction scar to form, to create collateral circulation and
to restore the contractility of the damaged (but not necrotic) areas of the myocardium
• To avoid late infarction complications, all procedures excluding emergency treatment should
be avoided in this period.
• This also applies to dental surgery
In addition,
On the 2nd day after MI patients are subjected to early cardiac
rehabilitation

This is continued after discharge in rehabilitation centres, where

patients undergo fitness tests in the 1st month of convalescence.

When the patient’s test tolerance is found to be good, the risk of

recurrence is considered low, and if the attending physician does not
find otherwise, there are no contraindications to dental treatment.
 Most authors recommend a cautious 4 – 6-
week period after myocardial infarction to
Appropriate stabilize the disease
time to start
dental During this period, the most indispensable
treatment in procedures, such as extractions, the
post- drainage of abscesses or pulpotomies can
be performed in a hospital setting.
myocardial
infarction After this period, unless the cardiologist
patients recommends otherwise, complex dental
treatment can be carried out.
 Lack of chest pain for 2 weeks
post-PCI
Ensure
patients
having the Satisfactory test results during
good follow up

determinants
of condition
Symptoms are in constant
intensity, predictable and occur
only after intense physical activity
 • Today the risk of complications of dental
procedures is dependent more on the
anticoagulant therapy used than on the
severity of coronary heart disease
Haemostasis • Antiplatelet drugs, vitamin K antagonists or
in post- new non-vitamin K antagonist oral
anticoagulants (NOACs)
myocardial • The discontinuation of therapy with these
infarction drugs is associated with a high risk of
complications, including death
patients • This risk far exceeds the risk of increased
bleeding during and after surgery
• In addition, a surgical intervention itself
increases the risk of deep vein thrombosis
 Including acetylsalicylic acid (ASA) and an
inhibitor of the P2Y12 glycoprotein receptor
(clopidogrel, prasugrel or ticagrelor)

Double anti- Aim: Prevent thrombosis in the coronary artery

platelet
therapy The risk of thrombosis lasts until the
atherosclerotic plaque stabilizes (a process taking
(DAPT) about 4–6 weeks)

In the case of stent implantation − until it is

covered with the vascular endothelium

• Metal stents is 1 month

• Coated stents 6–12 months