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Ischaemic and bleeding events after complex versus non-complex PCI: a systematic review and meta-analysis
Insights
Complex percutaneous coronary intervention (PCI) increases the risk of myocardial infarction, bleeding, and death compared to non-complex PCI. This systematic review highlights the elevated risks associated with complex PCI procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Statistics
Background:
- Complex percutaneous coronary intervention (PCI) is increasingly utilized in myocardial revascularization.
- Understanding the risks associated with complex PCI is crucial for patient management.
Purpose of the Study:
- To systematically review and meta-analyze the association between complex PCI and ischemic and bleeding outcomes.
- To evaluate the certainty of evidence for these associations using the GRADE framework.
Main Methods:
- A systematic review and Bayesian meta-analysis of studies reporting adjusted and unadjusted risk estimates.
- Inclusion of data from 290,039 patients, with 33% undergoing complex PCI.
- Assessment of outcomes including myocardial infarction, major bleeding, death, stent thrombosis, revascularization, and stroke.
Main Results:
- Complex PCI was associated with a significantly higher risk of myocardial infarction (aHR 1.71), major bleeding (aHR 1.24), all-cause death (aHR 1.21), cardiovascular death (aHR 1.29), stent thrombosis (aHR 1.76), target lesion/vessel revascularization (aHR 1.99), and stroke (aHR 1.21).
- The posterior probability of increased risk for complex PCI was >99% across all outcomes.
- Certainty of evidence was moderate to high for most outcomes, except for stroke (low certainty).
Conclusions:
- Patients undergoing complex PCI face a substantially increased risk of both ischemic and bleeding events compared to those receiving non-complex PCI.
- These findings underscore the importance of careful patient selection and procedural planning in complex PCI.
Background:
Complex percutaneous coronary intervention (PCI) is increasingly performed among patients undergoing myocardial revascularisation.
Aims:
We conducted a systematic review and meta-analysis to evaluate the association between complex PCI and the risk of ischaemic and bleeding outcomes.
Methods:
Hazard ratios (HRs) were pooled using a random-effects model within a Bayesian framework. The primary analysis was restricted to studies providing adjusted risk estimates, whereas the secondary analysis included unadjusted risk estimates. The primary outcomes were myocardial infarction and major bleeding. The secondary outcomes were all-cause death, stent thrombosis, cardiovascular death, target lesion or vessel revascularisation, and stroke. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for prognostic studies was used to determine the level of certainty in the association between complex PCI and the risk of events.
Results:
We included 290,039 patients, of whom 94,633 (33%) underwent complex PCI. Compared with non-complex PCI, patients undergoing complex PCI had a higher risk of myocardial infarction (adjusted HR 1.71, 95% credible interval [CrI]: 1.49-1.96), major bleeding (adjusted HR 1.24, 95% CrI: 1.14-1.35), all-cause death (adjusted HR 1.21, 95% CrI: 1.12-1.32), cardiovascular death (adjusted HR 1.29, 95% CrI: 1.15-1.46), stent thrombosis (adjusted HR 1.76, 95% CrI: 1.49-2.14), target lesion or vessel revascularisation (adjusted HR 1.99, 95% CrI: 1.58-2.50), and stroke (adjusted HR 1.21, 95% CrI: 1.03-1.42). The posterior probability of a higher risk associated with complex versus non-complex PCI was >99% for all study outcomes. Except for stroke (which was low certainty), the certainty of evidence was moderate to high for all other outcomes. Secondary analysis, including unadjusted risk estimates, provided consistent results.
Conclusions:
Patients undergoing complex PCI have an increased risk of both ischaemic and bleeding events compared with patients undergoing non-complex PCI (PROSPERO: CRD420250656254).
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