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. 2022 Dec 8;24(Suppl J):J4-J10.
doi: 10.1093/eurheartjsupp/suac060. eCollection 2022 Nov.

Optimized patient selection in high-risk protected percutaneous coronary intervention

Jürgen Leick  1 , Nikos Werner  1 , Norman Mangner  2 , Vasileios Panoulas  3   4 , Cristina Aurigemma  5
Affiliations

Optimized patient selection in high-risk protected percutaneous coronary intervention

Jürgen Leick et al. Eur Heart J Suppl. .

Abstract

Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients with poor left-ventricular (LV) function undergoing elective high-risk percutaneous coronary interventions (HR-PCIs). These patients are often in critical condition and not suitable candidates for coronary artery bypass graft surgery. For the definition of HR-PCI, there is a growing consensus that multiple factors must be considered to define the complexity of PCI. These include haemodynamic status, left-ventricular ejection fraction, clinical characteristics, and concomitant diseases, as well as the complexity of the coronary anatomy/lesions. Although haemodynamic support by percutaneous LV assist devices is commonly adopted in HR-PCI (protected PCI), there are no clear guideline recommendations for indication due to limited published data. Therefore, decisions to use a nonsurgical, minimally invasive procedure in HR-PCI patients should be based on a risk-benefit assessment by a multidisciplinary team. Here, the current evidence and indications for protected PCI will be discussed.

Keywords: Comorbidities; Haemodynamic support; High-risk PCI; Left-ventricular function; Mechanical circulatory support; Protected PCI.

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Conflict of interest statement

Conflict of interest: J.L. has received research funds that were paid to the institution from Shockwave Medical Inc, and payment or honoraria from AstraZeneca and Boston Scientific, outside the submitted work. C.A. has received speaker fees from Abbott, Abiomed, Medtronic, and Daiichi Sankyo. N.M. has received consulting fees from Abiomed, B. Braun, Biotronik, Boston Scientific, Pfizer, and Sanofi Genzyme, payment or honoraria from Abbott, Abiomed, AstraZeneca, Bayer, B. Braun, Biotronik, Boston Scientific, Edwards Lifesciences, Medtronic, Novartis, Pfizer, and Sanofi Genzyme, and was a National PI for the PROTECT IV Trial from Abiomed. N.W. received support for the present manuscript from Abiomed, grants or contracts from Shockwave and Abiomed, payment or honoraria from Abiomed, Boston Scientific, and Shockwave, support for attending meetings and/or travel from Medtronic, Edwards, and Abiomed, and participated on a data safety monitoring board or advisory board at Cingular. V.P. has received consulting fees from Abiomed, and payment from Abiomed.

Figures

Figure 1
Figure 1
Criteria for high-risk percutaneous coronary intervention patients.
Figure 2
Figure 2
Decision-making process of protected percutaneous coronary intervention.
See this image and copyright information in PMC

References

    1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto Uet al. . 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019;40:87–165. - PubMed
    1. Becher T, Baumann S, Eder F, Perschka S, Lossnitzer D, Fastner C, et al. . Comparison of peri and post-procedural complications in patients undergoing revascularisation of coronary artery multivessel disease by coronary artery bypass grafting or protected percutaneous coronary intervention with the Impella 2.5 device. Eur Heart J Acute Cardiovasc Care 2019;8:360–368. - PubMed
    1. Baumann S, Werner N, Ibrahim K, Westenfeld R, Al-Rashid F, Sinning JM, et al. . Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella(R) pump: results from the German Impella(R) registry. Clin Res Cardiol 2018;107:653–657. - PubMed
    1. Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O’Neill WWet al. . Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention. Circulation 2016;134:422–431. - PMC - PubMed
    1. Brener SJ, Cunn GJ, Desai PH, Faroqui M, Ha LD, Handa Get al. . A novel risk score to predict one-year mortality in patients undergoing complex high-risk indicated percutaneous coronary intervention (CHIP-PCI). J Invasive Cardiol 2021;33:E253–E258. - PubMed