Virtual reality in percutaneous coronary intervention: from coronary imaging and procedural planning to patient care

Percutaneous coronary intervention (PCI) is one of the most frequently performed invasive procedures in medicine, yet it remains technically demanding, carries a long operator learning curve, exposes both patients and staff to ionising radiation, and is a recognised source of patient anxiety. Virtual reality (VR), which represent immersive, computer-generated environments experienced through a head-mounted display, has been proposed as a potential tool across the PCI pathway. This narrative review synthesises literature from the last five years on four domains in which VR has been applied to PCI: (1) operator training and skill acquisition; (2) patient-specific pre-procedural planning and rehearsal; (3) intraprocedural visualisation and guidance (where VR overlaps with augmented and mixed reality); and (4) patient-centred applications including periprocedural anxiety and pain management, education, and rehabilitation after myocardial infarction or revascularisation. The evidence is heterogeneous and dominated by small studies, feasibility reports, and a growing number of randomised trials in the patient-anxiety domain. Immersive VR reduces periprocedural anxiety and represents the most clinically mature application to date, although its analgesic effect is less consistent and it has not proven non-inferior to pharmacological sedation for pain; VR-based simulation can transfer skills to real catheterisation laboratory performance; and patient-specific VR can support planning in anatomically complex PCI. The principal barriers are the absence of robust haptic feedback, cost, limited validation, cybersickness, and a scarcity of outcome-driven randomised trials. VR is best understood not as a competitor to digital twins, physics-based simulation, or augmented/mixed reality, but as one complementary layer within a broader extended-reality ecosystem for coronary intervention. We outline priorities for future research, including standardised validation frameworks, integration with patient-specific digital twins, and adequately powered trials with clinical endpoints.