Optimized patient selection in high-risk protected percutaneous coronary intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Mechanical Circulatory Support

Background:

• High-risk percutaneous coronary interventions (HR-PCI) often involve patients with compromised left-ventricular (LV) function.
• These patients may be critically ill and unsuitable for coronary artery bypass graft surgery.
• Defining HR-PCI complexity involves hemodynamic status, LV ejection fraction, clinical factors, comorbidities, and coronary anatomy.

Purpose of the Study:

• To discuss current evidence and indications for protected percutaneous coronary intervention (PCI) using percutaneous mechanical circulatory support (pMCS).
• To highlight the need for a multidisciplinary approach in decision-making for pMCS in HR-PCI.
• To address the lack of clear guideline recommendations for pMCS in HR-PCI.

Main Methods:

• Review of current evidence on the use of pMCS in HR-PCI.
• Discussion of factors influencing the decision-making process for protected PCI.
• Analysis of risk-benefit assessments for employing minimally invasive procedures in HR-PCI patients.

Main Results:

• pMCS is increasingly utilized in HR-PCI for patients with poor LV function.
• Limited published data currently exists, leading to a lack of specific guideline recommendations.
• Multidisciplinary team assessment is crucial for risk-benefit evaluation in these complex cases.

Conclusions:

• Protected PCI with pMCS is a viable option for select HR-PCI patients with LV dysfunction.
• Further research and data are needed to establish clear guidelines for pMCS use in HR-PCI.
• Individualized risk-benefit assessment by a multidisciplinary team is paramount for optimal patient management.