Optimized patient selection in high-risk protected percutaneous coronary intervention

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 byp...

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Bibliographic Details
Published inEuropean heart journal supplements Vol. 24; no. Suppl J; pp. J4 - J10
Main Authors Leick, Jürgen, Werner, Nikos, Mangner, Norman, Panoulas, Vasileios, Aurigemma, Cristina
Format Journal Article
LanguageEnglish
Published England Oxford University Press 01.11.2022
Subjects
Best Practice Approach on High-Risk Percutaneous Coronary Intervention Supplement Paper
Haemodynamic support
Protected PCI
Comorbidities
High-risk PCI
Mechanical circulatory support
Left-ventricular function
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Summary: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.
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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.
ISSN:1520-765X
1554-2815
DOI:10.1093/eurheartjsupp/suac060