Magenta Elevate™ EFS in High-Risk PCI Patients

Inclusion Criteria: 1. Non-emergent, percutaneous coronary intervention is planned in at least one stenotic lesion of a native coronary artery or bypass graft (de novo or restenosis). 2. Ejection fraction of ≤ 50% and at least one of the following: 1. Intervention on an unprotected left main coronary artery 2. Intervention on a last patent coronary conduit 3. Three-vessel disease (in case of left coronary artery dominance, the combination of a left anterior descending artery (LAD) lesion and a proximal left circumflex artery (LCX) lesion qualifies as three-vessel disease). 3. A heart team that includes a cardiac surgeon has determined that high-risk PCI is the appropriate therapeutic option. 4. Subject signed informed consent. Exclusion Criteria: 1. Subject age \< 18 or ≥ 85 years. 2. Cardiogenic shock (systolic blood pressure \< 90 mmHg with evidence of end organ hypoperfusion, such as cool extremities or urine \< 30 mL/hour); acutely decompensated pre-existing chronic heart failure; any use of inotropic or vasopressor in the previous 48 hours; or any use of mechanical circulatory support or an extracorporeal membrane oxygenation device within 14 days. 3. Hypertrophic cardiomyopathy, restrictive cardiomyopathy, or constrictive pericarditis 4. Evidence of left ventricular thrombus. 5. Previous aortic valve replacement or repair or a heart-constrictive device. 6. Aortic stenosis 7. Aortic regurgitation (≥ 2+ on a 4-grade scale by Transthoracic Echocardiography). 8. Aortic pathology, such as aortic aneurysms, dissection, extreme tortuosity, calcifications, or prior aortic surgery, that could pose undue additional risk to the placement of a pLVAD device. 9. Left ventricle rupture. 10. Cardiac tamponade. 11. Subject is scheduled for a staged PCI within 90 days of the index procedure 12. Subject has any condition or scheduled surgery that will require discontinuation of the antiplatelet and/or anticoagulant therapy within 90 days of the index procedure. 13. Chronic renal dysfunction (eGFR \<30 mL/min/1.73 m²) and patients requiring renal replacement therapy with dialysis. 14. Known or suspected coagulopathy or abnormal coagulation parameters (defined as platelet count ≤ 100,000 or spontaneous INR ≥ 1.5 or known fibrinogen ≤ 1.5 g/L). 15. Infection of the proposed procedural access site or suspected systemic active infection, including any fever. 16. Active COVID-19 infection. 17. Stroke or transient ischemic attack within 6 months of enrollment. 18. Subject participation in another investigational drug or device trial (with the exception of post-market registries and observational studies, subject to Sponsor review and approval). 19. Female subjects who are pregnant or breast-feeding. 20. Any non-cardiac condition with a life expectancy \<24 months 21. Subject has other medical, social, or psychological problems that, in the opinion of the Investigator, compromises the subject's ability to provide written informed consent and/or to comply with study procedures. 22. Subject belongs to a vulnerable population defined as individuals with mental disability, persons in nursing homes, children, impoverished persons, homeless persons, nomads, refugees, and those permanently incapable of providing informed consent. Vulnerable populations also may include members of a group with a hierarchical structure such as university students, subordinate hospital and laboratory personnel, employees of the Sponsor, members of the armed forces, and persons kept in detention.