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Rivista sulle Malattie del Cuore e dei Vasi

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2018 Apr 11

DOI: 10.23736/S0026-4725.18.04679-0


lingua: Inglese

High-risk PCI: how to define it today?

Vincenzo DE MARZO, Domenico D’AMARIO, Mattia GALLI, Rocco VERGALLO, Italo PORTO

Interventional Cardiology Unit, Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy


Before the percutaneous spread, the mortality rate of patients with coronary heart disease not suitable for cardiac surgery was markedly high. This limit has been progressively exceeded with the advent of minimally invasive approaches, which, although was initially intended exclusively for low risk patients, was then employed in complex patients often too compromised to undergo cardiac surgery. Given to the rising of high-risk population, due to an increase of patients with multiple chronic conditions linked to the best care offered, we are witnessing an expansion of the high-risk percutaneous coronary interventions (PCI) population. Despite defining what high-risk is remains still unclear, all proposed definitions of high-risk PCI combine features related to three clinical areas: 1) patient risk factors and comorbidities (incorporating those which preclude surgical or percutaneous revascularization such as diabetes, COPD, CKD, lung disease, frailty, advanced age); 2) location of the disease and complexity of coronary anatomy (including multi-vessel disease, left main disease, CTO, bifurcations); 3) hemodynamic clinical status (ventricular dysfunction, concomitant valvular disease or unstable characteristics). Since cardiologists have ascertained the encouraging results in terms of efficacy and rewards compared to the low-risks patients, the important role of treating high-risk patients is becoming more and more relevant to the point that current guidelines have now changed the appropriateness of percutaneous interventions indications. Considering the complexity in managing higher-risk patients with coronary artery disease, the next step to ensure the best care for this type of patients is to create a team-based model of cooperation in order to properly establish the right treatment for the right patient.

KEY WORDS: High-risk - PCI - Definition

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Publication History

Article first published online: April 11, 2018
Manuscript accepted: April 4, 2018
Manuscript received: March 19, 2018

Per citare questo articolo

De Marzo V, D’Amario D, Galli M, Vergallo R, Porto I. High-risk PCI: how to define it today? Minerva Cardioangiol 2018 Apr 11. DOI: 10.23736/S0026-4725.18.04679-0

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