Procedural Complexity and Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention.

The impact of complex coronary anatomy on outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Patients from a large PCI referral center were labeled as HBR in presence of ≥1 major or ≥2 minor Academic Research Consortium HBR criteria and undergoing complex PCI if they had any of the following: ≥3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, stent length >60 mm, bifurcation lesion with ≥2 stents, PCI of chronic total occlusion, left main, saphenous venous graft or requiring the use of atherectomy. Primary outcomes at 1 year were major adverse cardiac event (MACE), a composite of all-cause death, myocardial infarction or target vessel revascularization, and major bleeding. Of 16,966 patients, 7,295 (43.0%) were HBR with 3,611 (49.5%) undergoing complex PCI and 9,671 (57.0%) were non-HBR with 4,103 (42.4%) undergoing complex PCI. At 1 year, patients with complex PCI had a higher risk of MACE in both HBR (adjusted Hazard Ratio [adj. HR] 1.78, 95% Confidence Interval [95% CI] 1.54 to 2.06) and non-HBR (adj. HR 1.82 95% CI 1.55 to 2.12, respectively, pint 0.64) groups and a higher risk of major bleeding (adj. HR 1.55, 95% CI 1.29 to 1.87 and adj. HR 1.36, 95% CI 1.03 to 1.78, respectively; pint = 0.46), as compared to patients undergoing noncomplex PCI. In conclusion, complex PCI was associated with significantly higher risk of ischemic and bleeding adverse outcomes at 1-year in both HBR and non-HBR patients.