High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular I

This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.g., residual symptoms), and for whom the Heart Team estimates that revascularisation may have a prognostic benefit (e.g., left main, last remaining vessel, multivessel disease with large areas of ischaemia); however, there is a lack of data regarding the size of this patient population. This document aims to guide interventional cardiologists on how to proceed with PCI in such high-risk patients with reduced left ventricular ejection fraction after the decision of the Heart Team is made that CABG - which overall is the guideline-recommended option for revascularisation in these patients - is not an option and that PCI may be beneficial for the patient. Importantly, when a high-risk PCI is planned, a multidisciplinary decision by interventional cardiologists, cardiac surgeons, anaesthetists and non-invasive physicians with expertise in heart failure management and intensive care should be agreed upon after careful consideration of the possible undesirable consequences of PCI, including futility, similar to the approach for structural interventions.

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Publication Details

Journal
EuroIntervention
Published
2024-12-30
DOI
https://doi.org/10.4244/eij-d-23-01100
Citations
3
Primary Topic
Coronary Interventions and Diagnostics
Type
article
Field-Weighted Citation Impact
1.72

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article

High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular I

Philip A. MacCarthy, Nicolas M. Van Mieghem, Rasha Al‐Lamee, Andreas Schäfer et al.
3 citations
EuroIntervention
Coronary Interventions and Diagnostics
1.72
article

High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular I

Philip A. MacCarthy, Nicolas M. Van Mieghem, Rasha Al‐Lamee, Andreas Schäfer, Giuseppe Tarantini, Guillaume Cayla, Mirvat Alasnag, Matthias Thielmann, Florian Schoenhoff, Thierry Lefèvre, Martin Czerny, Adam Witkowski, Roman Gottardi, Andreas Baumbach, Róisín Colleran, Daniele Giacoppo, Ariel Roguin, Giulio Stefanini, Adrian Banning, Nikos Werner, Piotr Buszman, Tanja K. Rudolph, Davide Capodanno, Francesco Burzotta, Dariusz Dudek, Christoph Naber, Carlos Collet
article en
3 citations

Abstract

This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.g., residual symptoms), and for whom the Heart Team estimates that revascularisation may have a prognostic benefit (e.g., left main, last remaining vessel, multivessel disease with large areas of ischaemia); however, there is a lack of data regarding the size of this patient population. This document aims to guide interventional cardiologists on how to proceed with PCI in such high-risk patients with reduced left ventricular ejection fraction after the decision of the Heart Team is made that CABG - which overall is the guideline-recommended option for revascularisation in these patients - is not an option and that PCI may be beneficial for the patient. Importantly, when a high-risk PCI is planned, a multidisciplinary decision by interventional cardiologists, cardiac surgeons, anaesthetists and non-invasive physicians with expertise in heart failure management and intensive care should be agreed upon after careful consideration of the possible undesirable consequences of PCI, including futility, similar to the approach for structural interventions.

EuroInterventionVol. 21(1)
Università Cattolica del Sacro Cuore (IT), Jagiellonian University (PL), St Bartholomew's Hospital (GB), Humanitas University (IT), University of Padua (IT), Imperial College Healthcare NHS Trust (GB), University of Freiburg (DE), Queen Mary University of London (GB), University Hospital of Bern (CH), Hillel Yaffe Medical Center (IL), Erasmus MC (NL), Agostino Gemelli University Polyclinic (IT), John Radcliffe Hospital (GB), Mater Misericordiae University Hospital (IE), Medizinische Hochschule Hannover (DE), Krankenhaus der Barmherzigen Brüder Trier (DE), Onze Lieve Vrouwziekenhuis Hospital (BE), King Fahd Armed Forces Hospital (SA), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Institute of Cardiology (PL), William Harvey Research Institute (GB), King's College Hospital (GB), IRCCS Humanitas Research Hospital (IT), Imperial College London (GB)
Amgen, Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Edwards Lifesciences, Boston Scientific Corporation, Uniwersytet Jagielloński Collegium Medicum, Queen Mary University of London, Royal College of Surgeons in Ireland, JenaValve, Abiomed, Imperial College London, Imperial College Healthcare NHS Trust, King's College London, Canada Excellence Research Chairs, Government of Canada, Università degli Studi di Padova, Novo Nordisk, Università di Catania, Medizinischen Hochschule Hannover, Università Cattolica del Sacro Cuore, Université de Montpellier, Humanitas University, Siemens Healthineers, MicroPort, Humanitas Research Hospital, CytoSorbents Europe, Erasmus Universitair Medisch Centrum Rotterdam, Daiichi Sankyo Europe
Good health and well-being
Openalex Percentile: Top 14%
Coronary Interventions and Diagnostics
1.72
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