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Updated: Jan 13, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Procedural Complexity and Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention

Ridhima Goel1, Alessandro Spirito2, Davide Cao2

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

The American Journal of Cardiology
|January 7, 2026
PubMed

Insights

Complex percutaneous coronary intervention (PCI) increases risks for high bleeding risk (HBR) and non-high bleeding risk patients. Both groups face higher rates of major adverse cardiac events and major bleeding after complex PCI compared to non-complex procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • The outcomes of complex percutaneous coronary intervention (PCI) in patients with high bleeding risk (HBR) are not well-established.
  • Complex PCI involves treating multiple vessels/lesions, using long stents, or addressing challenging anatomy like chronic total occlusions or left main disease.

Purpose of the Study:

  • To evaluate the impact of complex PCI on major adverse cardiac events (MACE) and major bleeding in HBR and non-HBR patients.
  • To compare outcomes between complex and non-complex PCI procedures in a large patient cohort.

Main Methods:

  • Retrospective analysis of 16,966 patients undergoing PCI at a referral center.
  • Patients were categorized as HBR based on established criteria.
  • Complex PCI was defined by specific procedural characteristics (e.g., number of vessels/stents/lesions treated, stent length, specific lesion types).

Main Results:

  • Complex PCI was associated with a significantly higher risk of MACE in both HBR (adj. HR 1.78) and non-HBR (adj. HR 1.82) patients compared to non-complex PCI.
  • Major bleeding risk was also elevated after complex PCI in both HBR (adj. HR 1.55) and non-HBR (adj. HR 1.36) groups.
  • These associations remained significant regardless of bleeding risk status.

Conclusions:

  • Complex PCI independently increases the risk of both ischemic events (MACE) and major bleeding at one year.
  • The findings highlight the need for careful consideration of procedural complexity in patients undergoing PCI, particularly those at high bleeding risk.

Keywords:
clinical outcomescomplex PCIhigh bleeding riskmajor adverse cardiac eventspercutaneous coronary intervention

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