**3.1 Indications for PCI**


mortality with this disease has decreased, but still it accounts for approximately one-third of all the deaths in people over the age of 35 years. The American Heart Association reported that nearly 16.5 million people (20 years or more age) had

Coronary artery disease is the narrowing or occlusion of the vessel lumen due to arterial wall thickening caused by subintimal deposition of atheroma and loss of elasticity of the arterial wall. Atherosclerosis involves the proximal portions of the coronary arteries, specifically at the branching sites. In the beginning it only affects the flow reserve of the coronary artery, but as it advances, it affects the blood flow even at rest and leads to myocardial ischemia or infarction depending on the severity of the disease. This can be divided as supply ischemia (myocardial infarction and unstable angina) and demand ischemia (stable angina as during exercise, fever, emotional stress, etc.) [2]. The subendocardium is most vulnerable to myocardial ischemia due to the limited collateral blood flow. Therefore myocardial necrosis progresses from the subendocardium to the epicardium with continuing ischemia. A 75% cross-sectional area loss (50% diameter) is considered an important but moderate stenosis, while a 90% cross-sectional area loss (67% diameter) is consid-

There are three methods of treating coronary artery disease—medical management, percutaneous intervention, and coronary artery bypass graft surgery [4, 5].

1.Aspirin—it should be used daily in the case of stable angina. Daily use of aspirin in stable angina decreases myocardial infarction and sudden death. Its role is very important in unstable angina and myocardial infarction. Aspirin

2.Platelet inhibitors—it inhibits the binding of the ADP to platelet P2Y12 receptors and consequently inhibits activation of GPIIb/IIIa complex. Therefore it inhibits platelet aggregation. Clopidogrel is recommended if patient is intolerable to aspirin or there are adverse or side effects of aspirin such as GI bleeding or allergic reaction [6]. Both aspirin and clopidogrel are

coronary artery disease in 2017, with male predominance of 55% [1].

*Relationship between loss of cross-sectional area and diameter of the vessel.*

*The Current Perspectives on Coronary Artery Bypass Grafting*

ered severe stenosis (**Figure 1**) [3].

**Figure 1.**

**80**

**2. Medical management of coronary artery disease**

should also be continued after PCI or CABG.


### **3.2 Absolute contraindication**

