Patient selection for complex, high-risk indicated percutaneous coronary intervention procedures: an overview.

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine

Background:

• Percutaneous coronary intervention (PCI) has advanced significantly, yet coronary artery bypass grafting remains preferred for complex coronary artery disease.
• Many patients with complex disease are older with comorbidities, making them poor surgical candidates and increasing interest in less invasive options.
• This has led to the rise of complex, high-risk indicated PCI (CHIP) and protected PCI, especially for those needing mechanical circulatory support (MCS).

Purpose of the Study:

• To review contemporary evidence and consensus frameworks regarding CHIP.
• To delineate the multifactorial nature of CHIP risk.
• To organize key determinants of CHIP risk into distinct categories for better understanding and patient selection.

Main Methods:

• Synthesis of available contemporary evidence.
• Review of consensus frameworks.
• Organization of CHIP risk determinants into four categories: complex coronary anatomy, impaired hemodynamics, cardiac comorbidities, and non-cardiac comorbidities.

Main Results:

• CHIP involves anatomical complexity and heightened procedural risk due to hemodynamic compromise and patient comorbidities.
• Patient selection for MCS in CHIP relies heavily on observational data from registries, expert consensus, and institutional experience.
• Key determinants of CHIP risk include complex coronary anatomy, impaired hemodynamics, cardiac comorbidities, and non-cardiac comorbidities.

Conclusions:

• Understanding the multifactorial nature of CHIP risk is essential for decision-making.
• Identifying and categorizing risk factors aids in selecting appropriate patients for CHIP and MCS.
• Optimizing outcomes in this vulnerable population requires a comprehensive assessment of anatomical, hemodynamic, and comorbidity factors.