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Updated: Mar 17, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of
Ajay J Kirtane1, Darshan Doshi2, Martin B Leon2
1From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.). akirtane@columbia.edu.
Insights
Percutaneous coronary intervention is evolving to safely treat high-risk patients with severe coronary artery disease. Specialized interventional cardiology training is crucial for selecting and performing these complex revascularization procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Severe coronary artery disease (CAD) patients at high procedural risk are often underserved.
- Advances in percutaneous coronary intervention (PCI) techniques and patient selection are expanding treatment options.
- This population presents unique challenges due to comorbidities, complex anatomy, and hemodynamic instability.
Purpose of the Study:
- To explore the evolving role of PCI in high-risk severe CAD patients.
- To highlight the need for specialized training in interventional cardiology for complex PCI.
- To discuss preprocedural assessments and identify knowledge gaps for improving outcomes.
Main Methods:
- Review of current percutaneous interventional techniques and technologies.
- Analysis of patient selection criteria for high-risk individuals.
- Discussion of multidisciplinary risk and treatment assessment strategies.
Main Results:
- Current PCI may safely benefit carefully selected high-risk patients previously excluded from revascularization.
- There is a growing need for dedicated interventional cardiology specialists skilled in complex PCI.
- Multidisciplinary preprocedural evaluation is essential for successful outcomes.
Conclusions:
- Contemporary interventional cardiology must evolve to manage increasingly complex, higher-risk patients.
- Specialized training and refined patient selection are key to optimizing PCI outcomes in this population.
- Further research is needed to address knowledge gaps and improve long-term results.
Abstract:
Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.
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