High-risk percutaneous coronary intervention: how to define it today?

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Minimally Invasive Surgery

Background:

• Historically, patients with coronary heart disease unsuitable for surgery faced high mortality.
• Minimally invasive percutaneous coronary interventions (PCI) evolved from low-risk to complex cases.
• There is a growing trend of performing PCI in high-risk, complex patients, increasing resource demands.

Purpose of the Study:

• To review the current literature on the definition of high-risk PCI.
• To explore the implications of high-risk PCI in interventional cardiology.
• To assess the efficacy and health status gains of PCI in high-risk populations.

Main Methods:

• Literature review of studies defining and evaluating high-risk PCI.
• Analysis of clinical factors contributing to high-risk PCI definitions.
• Comparison of outcomes between high-risk and low-risk PCI patients.

Main Results:

• High-risk PCI definitions integrate patient comorbidities, disease complexity, and hemodynamic status.
• Key factors include diabetes, COPD, CKD, frailty, advanced age, multi-vessel disease, left main disease, CTOs, bifurcations, and ventricular dysfunction.
• PCI in high-risk patients demonstrates encouraging efficacy and significant improvements in health status compared to low-risk groups.

Conclusions:

• Treating high-risk patients with PCI is increasingly recognized as relevant and appropriate.
• Current guidelines emphasize the suitability of percutaneous interventions for complex, high-risk cardiovascular cases.
• PCI offers a viable and effective revascularization strategy for patients previously excluded from treatment.