“We are in an era of great efficacy and safety!” Dr Dario Echeverri， Colombia， presented his overview of the complications seen from today’s cardiovascular procedures in a SOLACI session in the afternoon，March 16. PCI however is not risk-free or complication-free and no patient should undergo PCI without understanding the risks. The evaluation of risk is multi-factorial and should be part of patient-centred care supported by complete and adequate information collation， the doctor-patient relationship and informed consent. An adequate adherence to basic “guidelines” offers legal protection to practitioners in the event of any perceived malpractice. There are additional costs to cardiovascular complications post-procedure beyond those suffered directly by patients. The economic impact is truly massive but just as importantly， the loss of confidence in health care providers. Dr Echeverri quoted the statistic that a stay in hospital induced a risk twenty times greater than having a car accident. “Without safety we don’t have quality”.
　　Over the last decade， the evolution of devices and techniques， from POBA， through bare metal stents and to DES as well as operator skills， has seen well documented and dramatic improvements in coronary perforations， restenosis rates (45% to less than 5%) and stent thrombosis (now as low as 0.1% at 12 months). But the physician’s knowledge and experience are of great value in predicting specific risk. Dr Echeverri said the need to estimate objective risks is of great importance and the use of clinical tables and mathematical scores would reduce bias drawing on data from history， physical examination and laboratory test results. He went on to demonstrate several studies identifying risk factors and using risk scores and algorithms to determine cardiovascular procedural risks such as PCI mortality， PCI in STEMI， bleeding incidence， vascular complications， contrast-induced nephropathy and exposure to imaging radiation during procedures.
　　There is a new culture of “patient safety” amongst members of the health care fraternity， and the use of risk scores are useful in the evaluation of individual patients and the analysis of medical errors in the past should lead to improvements in procedural processes at all stages.