Aditya Bharadwaj, MD, FACC, FSCAI, discusses patient identification for high-risk PCI (HRPCI) and cardiogenic shock (CS) at a gathering of East Coast fellows. He discusses methods for classifying complexity of coronary artery disease and the evolving landscape of PCI patients. Dr. Bharadwaj presents a case example highlighting several aspects of HRPCI, including calcium modification and bifurcation stenting. He then briefly reviews clinical data supporting the use of Impella in HRPCI. Dr. Bharadwaj then discusses cardiogenic shock patients, focusing on the National Cardiogenic Shock Initiative (NCSI) study, the importance of early identification of shock and the impact of shock teams on improving outcomes.