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Updated: Jun 7, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
[Percutaneous Coronary Intervention in High-Risk Patients]
1Vishnevsky National Medical Research Center of Surgery; Russian Medical Academy of Continuous Professional Education.
Insights
High-risk percutaneous coronary intervention (PCI) is for patients with severe ischemic heart disease and comorbidities who are ineligible for bypass surgery. Further study is needed on PCI criteria, indications, and outcomes for this complex patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Severe ischemic heart disease (IHD) with complex coronary artery disease (SYNTAX score >22) often leads to ineligibility for coronary artery bypass grafting (CABG).
- This scenario necessitates alternative revascularization strategies, leading to the concept of "high-risk percutaneous coronary intervention" (PCI).
- Current clinical guidelines often defer treatment decisions for these high-risk patients to a Heart Team consensus.
Purpose of the Study:
- To review and summarize the established criteria for performing high-risk PCI based on existing literature.
- To analyze the impact of various comorbidities on the outcomes of direct myocardial revascularization procedures in high-risk patients.
Main Methods:
- Literature-based analytical review.
- Synthesis of criteria for high-risk PCI.
- Analysis of comorbidity effects on revascularization outcomes.
Main Results:
- The review consolidates criteria defining high-risk PCI candidates.
- Comorbidities significantly influence the results of direct myocardial revascularization in this population.
- The Heart Team approach remains central to treatment strategy determination.
Conclusions:
- High-risk PCI represents a crucial alternative for patients with severe IHD and comorbidities unsuitable for CABG.
- Understanding specific criteria and the influence of comorbidities is essential for optimizing outcomes.
- Further research is warranted to refine indications and evaluate the long-term results of high-risk PCI.
Abstract:
Ischemic heart disease (IHD) with severe coronary artery disease (SYNTAX score >22 points) in combination with various comorbidities is often a reason for refusal of coronary artery bypass grafting in such patients. Thus, a new term has emerged, "high-risk percutaneous coronary intervention"; however, the criteria, indications and results of these interventions have not yet been sufficiently studied. Therefore, according to current clinical guidelines, the treatment tactics for this patient cohort is determined by the decision of a council, the so-called Heart Team. This analytical review summarizes the criteria for high-risk percutaneous coronary interventions based on the literature, and describes the effect of various comorbidities on the results of direct myocardial revascularization.
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