Journal
CIRCULATION
Volume 134, Issue 5, Pages 422-+Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.116.022061
Keywords
angioplasty; coronary artery disease; coronary occlusion; heart failure; percutaneous coronary intervention
Funding
- Boston Scientific
- Medtronic
- Abbott Vascular
- Abiomed
- St. Jude Medical
- Eli Lilly
- Abiomed Inc.
- Daiichi Sankyo
- Gilead Sciences
- Daiichi-Sankyo/Eli Lilly and Co
- AstraZeneca
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Janssen Pharmaceuticals
- Liposcience
- Medicines Company
- Merck/Schering Plow
- Pozen
- Roche
- Sanofi-Aventis
- WebMD
- Thoratec
- Heartware
- Cardiac Assist
- Maquet
- Bristol-Myers Squibb/Sanofi
- Eli Lilly and Co/Daiichi-Sankyo
- Covidien
- Regado Biosciences
- Maya Medical
- Merck Co
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Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.
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