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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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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
Summary
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.
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