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SCAI Position Statement on Optimal Percutaneous Coronary Interventional Therapy for Complex Coronary Artery Disease

Riley RF, et. al. for the Writing Group. Catheter Cardiovasc Interv. Published online. doi: 10.1002/ccd.28994.

Background:

This document is meant to discuss the approach to the high-risk PCI procedure defined by anatomic and patient features. The document is extensive and thus this commentary seeks to increase the awareness of some of the benefits and procedure related requirements within this topic which warrant consideration in the framework of achieving optimal PCI outcomes.

Key Points:

  • Pre-Procedural Assessment:
    • Coronary Anatomic Complexity – May require advanced techniques
    • Higher-risk clinical features
  • Emphasis on importance on multivessel disease
  • Procedure risk
  • Recognize high risk of surgical turndowns
  • Reduced left ventricular (LV) function
  • Acute Coronary Syndrome – Left Main (LM) and Low LVEF
    • Emphasized the importance of mechanical Support (MCS)
  • Most common is pVAD type of axial pump
  • MCS support shown to increase frequency of complete revascularization
  • Selected cases MCS supports improved LV function
    • Managing the risk of acute kidney injury
    • Miscellaneous
  • Concomitant valve disease
  • Diabetes
  • Treatment of complex coronary artery disease
    • Arterial access
    • Anticoagulation and antiplanet treatment
    • Intracoronary physiologic testing and imaging
    • Special lesion considerations – LM, Bifurcations, Vein Grafts, In-stent Restenosis and Chronic Total Occlusions.
  • The authors conclude: “…this SCAI consensus document provides an initial platform to offer guidance for achieving excellent outcomes for complex PCI and to support future investigations of this growing patient population.

Editorial Comment: This document provides an important roadmap for providing optimal outcomes for PCI in patients with complex coronary artery disease – Its more than “getting out of the lab”! it’s about getting optimal acute and late results. In the current era of COVID, certain of these recommendations become particularly important in attempting to reduce hospital