The risk of coronary perforation is approximately 0.2%, most commonly by wire perforation during PCI for CTO or by ablative or oversized devices during PCI of heavily diseased or tortuous coronary arteries.263 The risk of tampon- ade and management of the perforation varies with the type of Periprocedural bleeding is now recognized to be associated with subsequent mortality,265,266 and the avoidance of bleed- ing complications has become an important consideration in performing PCI. The risk of bleeding is associated with patient factors (eg, advanced age, low body mass index, CKD, baseline anemia), as well as the degree of platelet and thrombin inhibition, vascular access site, and sheath size.267 269 Issues of periprocedural bleeding are discussed in Section 4.7. The incidence of contrast-induced acute kidney injury (AKI) or contrast nephropathy in published reports depends on the definition of contrast nephropathy used and the frequency of risk factors for contrast-induced AKI in the patient population studied. Important risk factors for contrast- induced AKI include advanced age, CKD, congestive heart failure, diabetes, and the volume of contrast administered. Contrast-induced AKI and strategies to prevent it are dis- cussed in Section 4.4. 4. Preprocedural Considerations Table 4 contains recommendations for preprocedural consid- erations and interventions in patients undergoing PCI. 4.1. Cardiac Catheterization Laboratory Requirements Defibrillators are considered by The Joint Commission to be life-support equipment requiring routine assessment and completion of appropriate logs. Many hospitals require peri- odic inspection of consoles for ancillary devices used in coronary intervention (eg, Doppler wires, pressure-tipped sensor wires, and IVUS catheters). Point-of-care testing devices (eg, activated clotting time and arterial blood gas machines) require routine calibration. Duration of storage of digital cine images is often mandated by law. 