Chapter 22
High Risk Percutaneous Coronary Intervention
David A. Power,
Bimmer Claessen,
Samin K. Sharma,
David A. Power
Search for more papers by this authorBimmer Claessen
Search for more papers by this authorSamin K. Sharma
Search for more papers by this authorDavid A. Power,
Bimmer Claessen,
Samin K. Sharma,
David A. Power
Search for more papers by this authorBimmer Claessen
Search for more papers by this authorSamin K. Sharma
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorFirst published: 06 May 2022
Summary
High risk percutaneous coronary intervention (HR-PCI) encompasses a wide range of risk factors present in the modern catheterization lab. Patients categorized as HR-PCI typically have lower physiological tolerance for revascularization given their inherent anatomical, hemodynamic, and clinical characteristics. However, they represent a patient cohort that may more greatly benefit from complete revascularization. Mechanical circulatory support has been developed as a means to reduce the risk associated with “high-risk” PCI. Factors relevant to patient categorization can be broken down into three key areas: (i) anatomical criteria, (ii) hemodynamic criteria, and (iii) clinical/comorbid criteria. To date, few cardiovascular guidelines have outlined a clear definition of HR-PCI. Clinical evidence is lacking to accurately guide risk stratification, define choice of mechanical circulatory support (MCS), and influence outcomes. This chapter outlines the risk stratification of HR-PCI patients, outlines the evidence base underpinning MCS in HR-PCI and discusses a practical, integrated approach for HR-PCI.
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