Inclusion Criteria:  Impella-protected PCI selection criteria according to Virginia Commonwealth University (VCU) Complex PCI Program  Left ventricular ejection fraction (LVEF) ≤35% and ≥1 complexity feature LVEF ≤45% and estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2 and ≥1 complexity feature LVEF ≤45% and eGFR 31-45 ml/min/1.73 m2 and ≥2 complexity features  Complexity features  Planned treatment of ≥2 vessels Left main PCI Bifurcation intervention with 2-stent strategy Planned use of atherectomy (rotational, orbital, laser) Chronic total occlusion PCI PCI on last remaining vessel LVEDP >18 mmHg Cardiac index <2.0 l/min/m2 or pulmonary artery O2 saturation <55%  Exclusion Criteria:-  Pregnancy or lactation Presence of non-MRI compatible implanted medical device Known absolute contraindication to Impella insertion, e.g. severe peripheral arterial disease, left ventricular thrombus, aortic mechanical prosthesis, or severe aortic valve stenosis Chronic hemodialysis before the index procedure Status post-renal transplant Prisoners