Percutaneous Coronary Intervention Outcomes in Patients With Inflammatory Bowel Disease: A Comprehensive Review of Pathophysiology, Clinical Prognosis, and Management Strategies

Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is being increasingly recognized as a systemic inflammatory condition with a link to accelerated atherosclerosis and increased cardiovascular risk. Patients with inflammatory bowel disease are often younger and have fewer classical risk factors for coronary artery disease at the time of percutaneous coronary intervention, but there is an increasing body of evidence for an increased risk of adverse outcomes following the procedure. This review discusses the pathophysiologic connections between chronic intestinal inflammation and coronary artery disease, with special reference to endothelial dysfunction, hypercoagulability, immune activation, and the loss of the intestinal-vascular barrier in relation to unstable plaques and impaired vascular healing. A comprehensive review of the current literature, including cohort studies and pathophysiological research, was undertaken to assess the risk of short- and long-term outcomes following percutaneous coronary intervention in this group of patients. The current evidence clearly indicates that there is a 30-40% relative risk increase of major adverse cardiovascular events, including myocardial infarction and heart failure, in the short to long term compared to controls. The challenges in management include the difficulty in balancing dual antiplatelet therapy with increased gastrointestinal bleeding risk and the cardiovascular consequences of immunosuppressive therapy.