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Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O'Neill WW, Shroff A, Cohen MG, Palacios IF, Beohar N, Uriel N, Kapur NK, Karmpaliotis D, Lombardi W, Dangas GD, Parikh MA, Stone GW, Moses JW. Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of Contemporary Percutaneous Coronary Intervention. Circulation 2016; 134:422-31. [PMID: 27482004 DOI: 10.1161/circulationaha.116.022061] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
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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Affiliation(s)
- Ajay J Kirtane
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.).
| | - Darshan Doshi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Martin B Leon
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - John M Lasala
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - E Magnus Ohman
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William W O'Neill
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Adhir Shroff
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Mauricio G Cohen
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Igor F Palacios
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nirat Beohar
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nir Uriel
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Navin K Kapur
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Dimitri Karmpaliotis
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William Lombardi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - George D Dangas
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Manish A Parikh
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Gregg W Stone
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Jeffrey W Moses
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
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