Alexander Truesdell, M.D. and Alexandra Lansky, M.D. discuss four presentations originally given at the Transcatheter Cardiovascular Therapeutics (TCT) meeting in October 2023. These presentations highlight novel approaches to high-risk percutaneous coronary intervention (PCI) risk stratification. “I think this was a really nice snapshot of contemporary practice,” Dr. Truesdell states as he highlights key points from a presentation defining characteristics of patients undergoing high-risk PCI with mechanical circulatory support (MCS). Next, Dr. Lansky discusses A-SMART-EF, a novel score for predicting mortality in patients undergoing Impella®-assisted PCI. Dr. Truesdell then discusses the impact of right ventricular dysfunction in patients undergong high-risk PCI, and Dr. Lansky concludes with data highlighting the relationship between procedural blood pressure and patient outcomes.