Perspective:

As interventional cardiologists perform percutaneous coronary intervention (PCI) in higher-risk patients, they have used different mechanical assist devices in an attempt to reduce periprocedural risk. The definition of what constitutes high-risk PCI remains controversial, but typically includes those undergoing PCI for unprotected left main, multivessel disease, last remaining vessel, compromised left ventricular function, and PCI of a vessel subtending a large territory on a background of severely depressed left ventricular function. It seems logical that we need to establish standardized criteria to define what high-risk PCI is to benchmark uniformity among future trials of high-risk PCI and be able to meaningfully compare outcomes of a specific intervention. Instead of determining which device is superior, we need to identify the patient, anatomic, hemodynamic, and procedural characteristics that may suggest adjunctive mechanical circulatory support may be necessary. Ultimately, it should be up to the multidisciplinary heart team to assess, on an individual basis, which patient may benefit from a particular device, and to ensure mechanical circulatory support availability in the catheterization laboratory as standby.