Coronary Revascularization in High-Risk Stable Patients With Significant Comorbidities: Challenges in Decision-Making

  • Joshua Schulman-MarcusEmail author
  • Kellsey Peterson
  • Riju Banerjee
  • Sanjay Samy
  • Neil Yager
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease


Purpose of review

There is a growing cohort of complex high-risk patients with stable ischemic heart disease (SIHD) who present for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). These patients are older, have complex coronary disease, and a substantial comorbidity burden including frailty. The procedural risks and outcomes of CABG and PCI in these patients are more difficult to assess based on the available literature, which has generally studied a younger population with a lower comorbidity burden.

Recent findings

There have been initiatives to recalibrate and expand risk models derived from procedural registries to inform the care of complex higher-risk patients, including patients “turned down” for CABG. There is greater recognition of the need for improved assessment of risk, quality, and benefits of coronary revascularization in higher-risk SIHD patients with a substantial comorbidity burden.


Clinicians and patients should be aware that there are significant evidence gaps regarding revascularization in complex high-risk patients. The limitations of procedural-derived risk scores should be understood when presenting treatment options. Future randomized controlled trials and expanded registries are greatly desired and should be achievable. Meanwhile, a multidisciplinary heart team approach should be employed for proper decision-making.


Coronary revascularization CABG PCI Risk estimation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joshua Schulman-Marcus
    • 1
    Email author
  • Kellsey Peterson
    • 2
  • Riju Banerjee
    • 1
  • Sanjay Samy
    • 3
  • Neil Yager
    • 1
  1. 1.Division of CardiologyAlbany Medical CenterAlbanyUSA
  2. 2.Division of MedicineAlbany Medical CenterAlbanyUSA
  3. 3.Division of Cardiothoracic SurgeryAlbany Medical CenterAlbanyUSA

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