Increases of biomarkers 3 times the 99th percentile upper reference limit were designated as defining PCI-related MI.240 According to this definition, 15% of patients undergoing PCI would be defined as having periprocedural MI.241,242 Issues in procedure-related MI are discussed in Section 5.10. The need for emergency CABG has dramatically decreased with advances in PCI technology, particularly coronary stents.243,244 Recently the NCDR reported the rate of emer- gency CABG at 0.4%.244 Procedure-related indications for CABG in 1 large series included coronary dissection (27%), acute artery closure (16%), perforation (8%), and failure to cross the lesion (8%).245 The strongest predictors of the need for emergency CABG in several analyses are cardiogenic shock (OR: 11.4), acute MI or emergency PCI (OR: 3.2 to 3.8), multivessel disease (OR: 2.3 to 2.4), and type C lesion (OR: 2.6).243,245 In-hospital mortality for emergency CABG ranges from 7.8% to 14%.243,245,246 In a contemporary analysis from the NCDR, the incidence of PCI-related stroke was 0.22%.247 In-hospital mortality in patients with PCI-related stroke is 25% to 30%.247,248 Factors associated with an increased risk of stroke include fibrinolytic therapy administered before PCI (OR: 4.7), known cerebro- vascular disease (OR: 2.20), STEMI as the indication for PCI (OR: 3.2), use of an intra-aortic balloon pump (IABP) (OR: 2.6), older age (OR: 1.17 per 5-year increase), and female sex.247 249 Initial imaging after a stroke in 1 small series revealed hemorrhagic etiology in 18%, ischemic etiology in 58%, and no clear etiology in 24%.248 One potential algo- rithm for the treatment of catheterization-related stroke has been recently proposed.250 This document includes no spe- cific recommendations for the management of PCI-related stroke but refers the reader to the AHA/American Stroke Association guidelines for the management of adults with Vascular complications from PCI are primarily related to vascular access. 