Percutaneous coronary intervention is NOT indicated for which scenario?

• A. Stable Angina
• B. Acute coronary syndrome
• C. Unstable angina
• D. STEMI

Answer: (A)

PCI is used to rapidly restore blood flow in scenarios of acute coronary ischemia or high-risk disease, where fixing a culprit lesion changes outcomes. In STEMI, PCI is the standard, time-critical reperfusion to save heart muscle. In unstable angina or NSTEMI, PCI is employed when there are ongoing symptoms or high-risk features to prevent further deterioration. Stable angina, on the other hand, represents predictable chest pain from a fixed narrowing managed primarily with medical therapy and risk-factor modification. Trials like COURAGE showed that adding PCI to optimal medical therapy does not improve survival or prevent myocardial infarction in stable coronary disease, so PCI is not routinely indicated for stable angina. It may be considered if symptoms persist despite maximal medical therapy or in certain anatomical circumstances, but the typical indication is acute or high-risk ischemia, not stable angina.