Key result
Combined ischemic and bleeding complications post-PCI linked to ~13-fold higher in-hospital mortality.
Why the study?
The mortality link and relative weight of ischemic versus hemorrhagic events after PCI remain unclear, particularly regarding their timing of occurrence.
Does the occurrence and timing of ischemic or bleeding complications after PCI affect all-cause mortality?
Cohort (n=54,599)
Yes
Does the occurrence and timing of ischemic or bleeding complications after PCI affect all-cause mortality?
Odds Ratio: 13.2 (95% CI 7–24.7)
Bleeding complications occurring late after discharge from PCI are associated with a higher risk of death than late ischemic complications.
Late bleeding after PCI was associated with higher mortality risk than early events; leaves open whether timing-specific strategies improve survival.
BACKGROUND: The link to mortality and respective weight of ischemic events, hemorrhagic events or both after percutaneous coronary interventions (PCI) remain unclear, especially in regards of the time of occurrence. OBJECTIVES: To compare the association between ischemic and bleeding complications and mortality according to the timing of their occurrence after PCI. METHODS: All patients included in the FRANCE PCI registry between 2014 and 2020 were categorized, according to the occurrence of an ischemic complication (stent thrombosis, myocardial infarction, stroke or unplanned revascularization), a major bleeding (BARC type≥3), both or none of these complications. The analysis was also performed according to the timing of the complication (in-hospital or within one year of PCI). The primary outcome was all-cause mortality, analyzed 1/ during the index hospitalization for PCI by multivariable logistic regression, and 2/ over different periods of time after discharge from the index hospitalization, with a piecewise Cox multivariable model using ischemic and hemorrhagic complications as time-dependent variables. RESULTS: A total of 54,599 patients were included (75% male, median age 69 years), with an acute PCI in 52.9% of the cases. During hospitalization, ischemic complications (aOR 8.4, 95% CI 6.4-10.9), bleeding complications (aOR 10.3, 95% CI 8.1-13.2), and their combination (aOR 13.2, 95% CI 7.0-24.7) were all associated with increased mortality. After discharge, both ischemic and bleeding complications remained significantly associated with all-cause mortality although the strength of these associations decreased over time. Late (beyond 24 weeks) bleeding complications were more strongly associated with mortality (aHR 6.0 95%CI:5.0-7.3) than late ischemic complications (aHR 2.5 95%CI:2.0-3.1). CONCLUSIONS: After PCI there is an incremental risk of death with ischemic, bleeding and the combination of ischemic and bleeding complications occurring during hospitalization. Bleeding complications late after discharge seem to bear a higher risk of death than ischemic complications.
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Giovachini et al. (2026) conducted a cohort in Percutaneous coronary intervention (PCI) (n=54,599). Ischemic and bleeding complications vs. No complications was evaluated on All-cause mortality (aOR 13.2, 95% CI 7.0-24.7). Ischemic complications, bleeding complications, and their combination after PCI were associated with increased in-hospital mortality (aOR 13.2; 95% CI 7.0-24.7 for the combination).
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