Despite advancements in medical and device therapies, ischemic heart disease remains a leading cause of mortality and morbidity. High-risk percutaneous coronary intervention (HRPCI) is a crucial option for patients unsuitable for surgery due to advanced age or significant comorbidities.
HRPCI is characterized by increased risk factors, categorized into patient features, anatomical complexity, and clinical hemodynamics, as published in Cardiovascular Innovations and Applications. Key patient-related risk factors include advanced age, frailty, diabetes mellitus, chronic kidney disease, and reduced left ventricular ejection fraction (< 35%). These conditions are associated with an increased risk of complications, including bleeding, myocardial infarction, and death.
Anatomical complexities, such as left main coronary artery stenosis, heavily calcified lesions, and chronic total occlusions, further complicate HRPCI.
Effective HRPCI requires pre-procedural planning and the use of advanced techniques and technologies. Mechanical circulatory support devices, such as intra-aortic balloon pumps and Impella, are utilized to enhance cardiac output, reduce myocardial oxygen consumption, and improve coronary perfusion, thereby mitigating the risks associated with HRPCI.
A multidisciplinary heart team manages high-risk patients. This team, comprising interventional cardiologists, cardiothoracic surgeons, and primary cardiologists, aims to provide comprehensive care and support decision-making.
HRPCI is a vital option for patients with complex coronary artery disease. The heart team approach and careful patient assessment are crucial for successful outcomes.
The authors reported no conflict of interest.