|Patient With Left Main, Last Remaining Conduit, or Severe Multivessel Disease||Anticipated Noncomplex PCI||Anticipated Technically Challenging or Prolonged PCI|
|Normal or mildly reduced left ventricular function||None||IABP/Impella as back up|
|Severe left ventricular dysfunction (EF <35%) or recent decompensated heart failure||IABP/Impella as back up||Impella or TandemHeart, choice dependent upon vascular anatomy, local expertise, and availability. ECMO for concomitant hypoxemia or RV failure.|
A suggested schema for use of support devices for high-risk PCI based upon clinical and anatomic circumstances. The greater the likelihood of hemodynamic compromise or collapse the greater the potential benefit of MCS.