Clinical Outcomes After Percutaneous Coronary Intervention in Patients With Cirrhosis: A Multicentre National Study

Coronary artery disease (CAD) is common in cirrhosis patients because of shared risk factors, including metabolic syndrome and alcohol use; however, outcomes after percutaneous coronary intervention (PCI) remain poorly defined.

To evaluate outcomes after PCI in patients with cirrhosis.

We conducted a retrospective cohort study using TriNetX US Collaborative Network data from 2015 to 2024. Adults undergoing PCI were stratified by cirrhosis status, with outcomes including gastrointestinal bleeding, ischaemic events, and all-cause mortality. Within the cirrhosis cohort, we evaluated effect modification by aetiology, disease severity, and antiplatelet strategy at 30 days after PCI. One-to-one propensity score matching adjusted for demographics and comorbidities, with results reported as relative risks and 95% confidence intervals.

Among 3351 patients with cirrhosis undergoing PCI matched 1:1 to controls, cirrhosis was associated with higher 1-year gastrointestinal bleeding (16.14% vs. 8.12%; p < 0.0001) and mortality (13.97% vs. 10.41%; p < 0.0001). Decompensated cirrhosis had higher gastrointestinal bleeding and mortality than compensated disease, while alcohol-associated cirrhosis had higher gastrointestinal bleeding than metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis. In a 30-day landmark analysis, antiplatelet monotherapy (aspirin or P2Y12 inhibitors) had lower 1-year gastrointestinal bleeding (10.31% vs. 20.77%; p < 0.0001) and mortality (9.46% vs. 12.89%; p = 0.04) without increased stent restenosis compared with dual antiplatelet therapy (DAPT).

Cirrhosis confers substantially higher bleeding and mortality after PCI, particularly in decompensated disease. Antiplatelet monotherapy after 30 days was associated with less bleeding and improved survival, supporting abbreviated DAPT in this high-risk group.