Ischemic and bleeding risk after complex percutaneous coronary intervention in patients with or without high bleeding...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Practice

Background:

• The utility of complex percutaneous coronary intervention (PCI) criteria for risk stratification in real-world practice remains inadequately evaluated.
• Assessing procedural complexity is crucial for managing patient outcomes after PCI.

Purpose of the Study:

• To evaluate the real-world utility of complex percutaneous coronary intervention (PCI) criteria.
• To determine if complex PCI criteria effectively stratify risk for ischemic and bleeding events.

Main Methods:

• Analysis of 7,871 patients undergoing first PCI from the CREDO-Kyoto registry cohort-2, excluding acute myocardial infarction and non-stent cases.
• Complex PCI defined by criteria including multiple vessels/stents/lesions, bifurcation stenting, long stent length, or chronic total occlusion target.
• Comparative analysis of ischemic and bleeding event rates between complex and non-complex PCI groups.

Main Results:

• Complex PCI (35% of patients) was associated with significantly higher risks of primary ischemic (15.4% vs. 10.9%) and bleeding (11.9% vs. 9.9%) endpoints compared to non-complex PCI.
• The elevated risks for both ischemic and bleeding events in complex PCI patients were predominantly observed within 30 days after the procedure.
• Hazard ratios indicated a significantly increased risk for ischemic events (HR: 2.19) and bleeding events (HR: 1.56) within 30 days for complex PCI.

Conclusions:

• Patients undergoing complex PCI face a higher risk of both ischemic and bleeding events compared to those undergoing non-complex PCI.
• The increased risk associated with complex PCI is concentrated within the initial 30-day period following the intervention.
• These findings underscore the clinical significance of complex PCI criteria in identifying high-risk patients in routine practice.