Table 2

Suggested Schema for Support Device in High-Risk PCI

Patient With Left Main, Last Remaining Conduit, or Severe Multivessel DiseaseAnticipated Noncomplex PCIAnticipated Technically Challenging or Prolonged PCI
Normal or mildly reduced left ventricular functionNoneIABP/Impella as back up
Severe left ventricular dysfunction (EF <35%) or recent decompensated heart failureIABP/Impella as back upImpella 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.