William O’Neill, MD, and panelists Aditya Bharadwaj, MD, Alexandra Lansky, MD, and Norman Mangner, MD, discuss not only how to define high-risk percutaneous coronary intervention (HRPCI), but also how to predict outcomes and optimal revascularization strategies. Dr. Bharadwaj describes the characteristics of high-risk PCI patients. Dr. Lansky explains how two existing risk scores-- NCDR Cath PCI and BCIS CHIP-PCI—overestimate outcomes in Impella®-supported HRPCI patients. Dr. Mangner discusses the ongoing PROTECT IV randomized controlled trial. The panelists engage in insightful discussion and answer questions between presentations.