BACKGROUND:Coronary sinus reducer (CSR) implantation is the only guideline-recommended percutaneous treatment for patients with refractory angina. Data from its real-world large-scale adoption are scarce. METHODS:This was a national audit of CSR implanting centres in the UK between November 2014 and 2024. Centres provided data on all patients undergoing clinical CSR implantation through a structured collection template. Data collected included demographics, medical history, medications, angina status, ischaemia testing, procedural characteristics and periprocedural complications. Prespecified endpoints were appropriate patient selection, procedural success and safety, and efficacy of CSR implantation. RESULTS:19 centres were included capturing 491 patients. Most were male (79%) with high rates of previous myocardial infarction (75%), percutaneous coronary intervention (78%) and coronary artery bypass grafting (69%). Diabetes mellitus (53%), hypertension (76%) and hypercholesterolaemia (78%) were prevalent. 74% had a preserved left ventricular ejection fraction (LVEF≥50%). Patients were severely symptomatic with 84% suffering from Canadian Cardiovascular Society (CCS) class ≥3 angina despite multiple antianginal medications (≥2 drugs 94%; ≥3 drugs 74%). Baseline ischaemia testing was common (79%). Successful CSR implantation was achieved in 95% of cases. 46 periprocedural adverse events (AEs) in 41 patients occurred (9.2%) most commonly due to access complications. Rates of major adverse cardiovascular events and severe AEs were low (<1%). 98% of patients stayed ≤1 night postprocedurally. Significant reductions in CCS class were observed at 6-month follow-up: 75% experienced ≥1 CCS class and 36% ≥2 CCS class angina reduction. Improved angina status was also observed after stratification by age, sex and diabetes mellitus. CONCLUSIONS:This national audit of real-world UK practice confirms CSR implantation is being performed appropriately and safely leading to symptom improvement for patients with refractory angina. Contemporary practice aligns with the recommendations of current guidelines supporting the continued use of CSR in UK clinical practice. Prospective data collection within a national registry is warranted.

BACKGROUND:Patients with prior coronary artery bypass grafting (CABG) account for around 10% of non-ST-elevation acute coronary syndromes (NSTE-ACS), but the optimal diagnostic and management strategy remains uncertain. Invasive coronary angiography (ICA) in this group is technically challenging, carries increased risk and often does not lead to percutaneous coronary intervention (PCI). CT coronary angiography (CTCA) may help identify which patients benefit from ICA and reduce unnecessary invasive procedures. METHODS:In the BYPASS-CTCA (Randomised Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) study, patients with prior CABG undergoing ICA were randomised to CTCA plus ICA or ICA alone. For this analysis, anonymised case vignettes and CTCA reports from 150 patients with NSTE-ACS were independently reviewed by 50 experienced interventional cardiologists (median 17 years post-qualification; 5103 total case reviews). Agreement on management strategy before and after CTCA was assessed using Fleiss' κ statistic. RESULTS:Based on clinical information alone, respondents chose medical therapy in 13.2% of cases, with poor agreement on management strategy (κ=0.14, 95% CI 0.11 to 0.17). After reviewing CTCA, agreement improved to moderate (κ=0.53, 95% CI 0.48 to 0.58; p<0.001), and medical management was selected in 39.3% (p<0.001). When invasive management was selected post-CTCA, PCI was required in 85% of cases, and a selective angiographic approach was planned in 79%. CONCLUSIONS:Management decisions for post-CABG NSTE-ACS vary widely among experienced cardiologists. Incorporating CTCA into the diagnostic pathway substantially improves consensus, reduces unnecessary invasive angiography and enables targeted, lower-risk procedures. These findings support evaluation of a CTCA-guided strategy in a prospective randomised trial.

BACKGROUND:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) has been associated with increased stent optimization and reduced adverse events among patients with complex coronary-artery lesions, but adoption of this strategy in Western countries remains low. Although practice guidelines recommend intracoronary imaging for anatomically complex lesions, evidence from current European practice is limited. METHODS:In this investigator-initiated, international, open-label, randomized, controlled trial, we assigned patients undergoing complex PCI to either IVUS-guided PCI, performed with the use of prespecified stent-optimization criteria, or angiography-guided PCI. The primary end point was target-vessel failure, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization. RESULTS:Of the 2020 patients who underwent randomization, 1010 in the IVUS-guided PCI group and 1009 in the angiography-guided PCI group were included in the primary analysis. The mean age of the patients was 69 years, 79.4% were men, and 27.4% presented with an acute coronary syndrome. The mean procedure duration was 88.8 minutes with IVUS-guided PCI and 66.2 minutes with angiography-guided PCI. Dilation with balloon angioplasty after stent implantation was performed in 91.3% of the IVUS-guided PCI procedures and in 84.5% of the angiography-guided PCI procedures. At a median follow-up of 19.0 months (interquartile range, 15.2 to 23.4), target-vessel failure had occurred in 140 patients (13.9%) in the IVUS-guided PCI group and in 112 patients (11.1%) in the angiography-guided PCI group (hazard ratio, 1.25; 95% confidence interval, 0.97 to 1.60; P = 0.08). Procedural complications occurred in 11.3% of the IVUS-guided PCI procedures and in 10.2% of the angiography-guided PCI procedures. The frequency of adverse events appeared to be similar in the two groups. CONCLUSIONS:Among patients undergoing complex high-risk PCI, a strategy of routine IVUS-guided PCI performed with the use of prespecified stent-optimization criteria was not associated with a lower risk of target-vessel failure than angiography-guided PCI alone. (Funded by Boston Scientific; IVUS-CHIP ClinicalTrials.gov number, NCT04854070.).

Intravascular ultrasound (IVUS) has been in clinical use for more than three decades. Despite evidence that supports the application of the technology from multiple registries, randomised trials and meta-analyses, adoption remains low. Potential barriers to the adoption of IVUS are a lack of understanding as to how to accurately interpret images and how to incorporate it into clinical workflow. To address this, this paper summarises evidence-based protocols for the application of IVUS during percutaneous coronary intervention (PCI) into an easily understood workflow. Standardisation of approaches and wider adoption of IVUS-optimised PCI should improve patient outcomes and PCI durability.

BACKGROUND:Percutaneous coronary intervention for coronary chronic total occlusion (CTO PCI) is offered for symptom and quality of life improvement, despite the absence of blinded randomized evidence. OBJECTIVES:The aim of this study was to assess the efficacy of CTO PCI in the first randomized, placebo-controlled trial of CTO PCI. METHODS:ORBITA-CTO is a multicenter, randomized, blinded trial comparing CTO PCI with a placebo procedure. Patients had angina attributable to a single-vessel CTO, without bystander coronary disease. Angina symptoms were recorded daily using the ORBITA app. After dual-injection coronary angiography, patients were randomized to either CTO PCI or placebo. Blinding was maintained using auditory isolation and deep conscious sedation. Antianginal medications were stopped at randomization and reintroduced on a patient-initiated protocol. At the 6-month follow-up, assessments were repeated. The primary efficacy outcome was the angina symptom score, an ordinal scale combining the daily symptom burden assessed by the ORBITA app, antianginal use, and over-ride events. Secondary outcomes were symptom and quality of life questionnaires and blinding fidelity. RESULTS:Between October 19, 2021 and October 21, 2025, 50 patients were randomly assigned to CTO PCI (n = 25) or placebo (n = 25). One patient randomized to PCI was withdrawn during the procedure because of a complication. All 50 patients were included in the primary analysis. Compared with placebo, CTO PCI resulted in an immediate and sustained improvement in the angina symptom score (OR: 4.38; 95% credible interval [CrI]: 1.57-12.69; probability of benefit [Pr{Benefit}] = 0.996), arising from a clear reduction in the number of episodes of angina (OR: 4.38; 95% CrI: 1.55-11.78; Pr[Benefit] = 0.997). This resulted in an additional 30.6 days free of angina (95% CrI: 11.1-50.7; Pr[Benefit] >0.999). Improvements were also observed with the Seattle Angina Questionnaire in angina frequency (+10.7; 95% CrI: 1.4-20.2; Pr[Benefit] = 0.988), physical limitation, quality of life, and summary score and Canadian Cardiovascular Society class. Blinding of patients, staff, and researchers was maintained. CONCLUSIONS:In patients with symptomatic single-vessel CTO, CTO PCI improves angina beyond placebo. (A Placebo-controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention for the Relief of Stable Angina [ORBITA-CTO]; NCT05142215).

BACKGROUND:Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking. AIMS:We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance. METHODS:Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation. RESULTS:In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51). CONCLUSIONS:OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.

BACKGROUND:Intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) has been associated with a reduction in clinical events. Whereas most evidence is generated in Asian-Pacific populations, its global adoption remains low. METHODS:The IVUS complex high-risk indicated procedures (CHIP) trial is a multicenter, international, event-driven, randomized superiority trial comparing IVUS-guided PCI with angio-guided PCI during complex high-risk indicated procedures. The primary endpoint is target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target vessel revascularization. The IVUS CHIP trial utilizes an event-driven approach. The outcomes for the primary endpoint are first reported when at least 169 patients with a primary endpoint have been confirmed. A total of 2020 patients will be enrolled in 37 European sites. CONCLUSIONS:The aim of the IVUS CHIP trial is to assess the superiority of an IVUS-guided approach vs an angio-guided approach in patients undergoing complex high-risk indicated procedures in terms of the study primary endpoint of target vessel failure. TRIAL REGISTRATION:The IVUS CHIP trial is registered at ClinicalTrial.gov and assigned the identifier NCT04854070.

BACKGROUND:In stable coronary artery disease, the primary goal of percutaneous coronary intervention (PCI) is symptom relief. Fractional flow reserve (FFR) and nonhyperemic pressure ratios such as resting full-cycle ratio (RFR) are used to guide revascularization. Although these indices correlate with myocardial ischemia, they have never been validated against the onset of angina. The physiological thresholds for angina, FFRangina and RFRangina, angina (FFRangina at rest and during exercise remain undefined. METHODS:ORBITA-FIRE (Finding the Invasive Threshold for Symptom Relief in Exertional Angina) was a multicenter, double-blind, randomized, placebo-controlled study in patients with stable angina and single-vessel coronary artery disease. After imaging-guided PCI, an in-stent balloon was incrementally inflated until angina occurred at rest. This angina threshold was verified against placebo inflation, and corresponding FFRangina and RFRangina values were recorded at symptom onset. The protocol was repeated during low- and high-intensity exercise to assess changes in angina thresholds with increasing cardiac workload. RESULTS:Sixty-five patients were enrolled (mean age, 63.9±8.7 years; 74% male; 69% hypertensive; 23% diabetic; 91% with Canadian Cardiovascular Society class II-III angina). Median pre-PCI FFR was 0.59 (interquartile range [IQR], 0.46-0.70) and RFR was 0.61 (IQR, 0.40-0.82). Median FFRangina at rest was 0.29 (IQR, 0.23-0.35), increasing to 0.38 (IQR, 0.30-0.48) during low-intensity exercise and 0.45 (IQR, 0.36-0.55) during high-intensity exercise. RFRangina similarly increased from 0.22 (IQR, 0.16-0.30) at rest to 0.26 (IQR, 0.18-0.36) and 0.32 (IQR, 0.23-0.46) during low- and high-intensity exercise. All thresholds were significantly lower than clinical diagnostic cut points (P<0.001). Lower FFRangina and RFRangina thresholds were associated with greater symptom reproducibility across rest, low- and high-intensity exercise conditions (FFRangina: P=0.008, P<0.001, P<0.001, respectively; RFRangina: P=0.015, P<0.001, P=0.002, respectively). Lower angina thresholds across all conditions predicted higher baseline angina burden and greater symptom relief with PCI (probability of interaction >0.999). CONCLUSIONS:Physiological thresholds for angina, FFRangina and RFRangina, are highly individualized, vary with cardiac workload, and are consistently lower than the universal ischemia-based thresholds used to guide revascularization. These findings support integrating personalized, symptom-linked physiology to refine patient selection and to improve symptomatic response to PCI.

BACKGROUND:In patients with prior coronary artery bypass grafting (CABG) presenting with graft failure, current guidelines recommend percutaneous coronary intervention (PCI) of the bypassed native coronary artery over PCI of the bypass graft. However, this recommendation relies solely on observational data. OBJECTIVES:This study compared clinical outcomes between a strategy of native vessel PCI with saphenous vein graft (SVG) PCI in post-CABG patients presenting with SVG failure. METHODS:The multicenter, randomized PROCTOR (Percutaneous Coronary Intervention of Native Coronary Artery versus Saphenous Vein Graft in Patients with Prior Coronary Artery Bypass Graft Surgery) trial included patients with significant SVG stenosis and a heart team-defined clinical indication for revascularization. Patients were randomly assigned (1:1) to either a strategy of native vessel PCI or SVG PCI using an interactive web-based randomization platform. The trial was conducted across 14 centers in Europe. We report the occurrence of major adverse cardiac events at 1 year following the index PCI, defined as the composite of all-cause mortality, nonfatal target coronary territory myocardial infarction (MI), or clinically driven target coronary territory revascularization, analyzed on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov (NCT03805048), and long-term follow-up is ongoing. RESULTS:Between January 2019 and December 2023, 220 patients (mean age 73 ± 7 years; 84% men [185/220 patients]) were randomized to a strategy of native vessel PCI (n = 108) or SVG PCI (n = 112). At 1 year, major adverse cardiac events occurred in 37 patients (34%) in the native vessel PCI group and 21 patients (19%) in the SVG PCI group (HR: 2.14; 95% CI: 1.25-3.65; P = 0.006). There was no significant difference in all-cause mortality (HR: 1.59; 95% CI: 0.45-5.64; P = 0.472), whereas both nonfatal target coronary territory MI (HR: 2.12; 95% CI: 1.08-4.17; P = 0.029) and clinically driven target coronary territory revascularization (HR: 2.19; 95% CI: 1.02-4.72; P = 0.044) occurred more frequently in patients assigned to native vessel PCI. The incidence of PCI-related MI was 13% in the native vessel PCI group and 1% in the SVG PCI group (HR: 14.85; 95% CI: 1.95-112.96; P = 0.009). CONCLUSIONS:In the randomized PROCTOR trial, SVG PCI was associated with improved 1-year clinical outcomes compared with native vessel PCI, primarily driven by lower rates of PCI-related MI and clinically driven target coronary territory revascularization.

Antegrade dissection reentry (ADR) uses the subintimal space to bypass occlusive plaque and reenter the true lumen distally. It is a fundamental strategy for chronic total occlusion (CTO) operators, contributing to high procedural success rates in CTO percutaneous coronary intervention. An ADR procedure can be divided into 3 key phases: proximal cap disruption and subintimal entry; extension of dissection through CTO body and targeted reentry into the distal true lumen. This review article provides a comprehensive overview of the commonly described ADR techniques.

BackgroundCoronary CT Angiography (CTA) is increasingly being used to plan percutaneous coronary intervention (PCI), offering detailed pre-procedural anatomical and physiological insights. The Precise Procedural and PCI Plan (P4) study evaluates the efficacy of CT- versus intravascular ultrasound-guided PCI. The aim of this study was to assess the utility of various CT-guided PCI tools and strategies as perceived by experienced operators within the context of the P4 study.MethodsA cross-sectional survey was conducted among 25 operators who participate in the P4 trial from multiple international centers. Participants were asked to evaluate the utility of pre-procedural CTA planning, physiological information with virtual PCI, and online guidance. The survey included multiple-choice, Likert scale, and ranking questions.ResultsMost respondents valued pre-procedural planning highly (average score 2.83/3), particularly for the assessment of plaque composition and calcium characterization. Plaque composition evaluation, including calcium analysis, was ranked as the most valued factor, with an average usefulness score of 6.13/7. Calcium arc information was rated as the most useful component of calcium analysis (4/5 rating). The survey highlighted the importance of myocardial mass at risk assessment in bifurcation PCI and pointed to the anticipation of calcium density as a key future aspect of CT-guided PCI procedures.ConclusionsThe integration of CT-guided PCI promises to refine procedural planning and to pave the way for a new standard of care in patients with stable CAD.

Optimizing decision-making remains essential in the management of stable coronary artery disease (CAD). Recent studies of the pullback pressure gradient (PPG), a novel tool for evaluating CAD patterns, have demonstrated that the effectiveness of percutaneous coronary intervention (PCI) is strongly influenced by the baseline CAD pattern (focal vs diffuse). The capacity of PPG to predict the success of PCI provides a means to better inform decision-making, revascularization strategies and, potentially, improve clinical outcomes.

BACKGROUND: ORBITA-2 (the Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI; however, their ability to predict placebo-controlled angina improvement is unknown. METHODS: Participants with angina, ischemia, and stable coronary artery disease were enrolled, and anti-anginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA smartphone symptom application (ORBITA-app). At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI was tested using Bayesian proportional odds modeling. RESULTS: Invasive physiology data were available for 279 patients (140 PCI and 139 placebo). The median (interquartile range) age was 65 years (59.0-70.5), and 223 (79.9%) were male. Median FFR was 0.60 (0.46-0.73), and median iFR was 0.76 (0.50-0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all end points. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR, 0.46 versus 0.73: odds ratio, 2.01; 95% credible interval, 1.79-2.26; probability of interaction, >99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have greater placebo-controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR, 0.50 versus 0.86: odds ratio, 2.13; 95% credible interval, 1.87-2.45; probability of interaction, >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina. CONCLUSIONS: Physiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit.

BACKGROUND:Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) typically involves extensive drug-eluting stent (DES) implantation. As a result, patients undergoing CTO PCI are exposed to a relatively high risk of in-stent restenosis and target lesion revascularization. While the application of drug-coated balloons (DCBs) may improve patient outcome by reducing stent burden, randomized controlled trials investigating the use of DCB in CTO PCI are lacking. METHODS:The Co-CTO trial (NCT04881812) is a single-blind, noninferiority randomized controlled trial enrolling 144 patients undergoing CTO PCI. A hybrid strategy (stenting of the CTO body and DCB treatment of adjacent disease) will be compared to a complete stenting strategy. The primary study endpoint is in-segment percentage diameter stenosis at 1 year follow-up determined by intravascular ultrasound. Secondary endpoints include major adverse cardiovascular events (a composite of cardiac death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization) at 1 year, angiographic outcomes, and cardiac symptoms (Canadian Cardiovascular Society Grading Scale, New York Heart Association Classification of Dyspnea). CONCLUSION:The Co-CTO trial is the first randomized controlled trial exploring a hybrid strategy (DES + DCB) in patients undergoing CTO PCI. TRIAL REGISTRATION:Registered at ClinicalTrials.Gov under registration number: NCT04881812 (https://clinicaltrials.gov/study/NCT04881812?cond=cto&intr=drug-coated%20balloon&rank=1).

Calcified nodules (CNs) represent significant challenges in percutaneous coronary intervention (PCI) due to their complex morphology, variable treatment responses, and association with stent failure due to reprotrusion or stent underexpansion. CNs are classified into eruptive and non-eruptive subtypes, each with distinct histological features and prognostic implications. Eruptive CNs are biologically active, being associated with a disrupted fibrous cap, overlying thrombus, and intraplaque haemorrhage, and they are thus more readily deformable by balloon dilation during PCI. Non-eruptive CNs, or nodular calcifications, tend to be stable, with an intact fibrous cap, and their deformability varies depending on the composition and base of the nodules. Enhanced angiography and intravascular imaging have greatly improved our understanding of CNs and may help to accurately identify nodule subtypes and guide treatment. Furthermore, understanding the deformability of CNs is crucial for optimising treatment outcomes. In this review, we discuss the identification and management of CNs in the context of PCI.

CTOs are frequently encountered in patients undergoing invasive coronary angiography. Even though technical progress in CTO-PCI and enhanced skills of dedicated operators have led to substantial procedural improvement, the success of the intervention is still lower than in non-CTO PCI. Moreover, the scores developed to appraise lesion complexity and predict procedural outcomes have shown suboptimal discriminatory performance when applied to unselected cohorts. Accordingly, we sought to develop a machine learning (ML)-based model integrating clinical and angiographic characteristics to predict procedural success of chronic total occlusion (CTO)-percutaneous coronary intervention(PCI). Different ML-models were trained on a European multicenter cohort of 8904 patients undergoing attempted CTO-PCI according to the hybrid algorithm (randomly divided into a training set [75%] and a test set [25%]). Sixteen clinical and 16 angiographic variables routinely assessed were used to inform the models; procedural volume of each center was also considered together with 3 angiographic complexity scores (namely, J-CTO, PROGRESS-CTO and RECHARGE scores). The area under the curve (AUC) of the receiver operating characteristic curve was employed, as metric score. The performance of the model was also compared with that of 3 existing complexity scores. The best selected ML-model (Light Gradient Boosting Machine [LightGBM]) for procedural success prediction showed an AUC of 0.82 and 0.73 in the training and test set, respectively. The accuracy of the ML-based model outperformed those of the conventional scores (J-CTO AUC 0.66, PROGRESS-CTO AUC 0.62, RECHARGE AUC 0.64, p-value <0.01 for all the pairwise comparisons). In conclusion, the implementation of a ML-based model to predict procedural success in CTO-PCIs showed good prediction accuracy, thus potentially providing new elements for a tailored management. Prospective validation studies should be conducted in real-world settings, integrating ML-based model into operator decision-making processes in order to validate this new approach.

Percutaneous techniques to treat obstructive coronary artery disease continue to evolve and the evidence base informing our practice is shared and summarised in international guidelines. In the UK, the British Cardiovascular Intervention Society represents and supports interventional cardiologists undertaking both coronary and structural interventions. Procedural data are collected in a national registry and these inform our understanding of UK practice and outcomes. These recommendations, pertaining to coronary intervention alone, are an update of those published in 2015 and describe the provision of percutaneous coronary intervention in the UK intended to provide optimal patient care.