Ischaemic and bleeding events after complex versus non-complex percutaneous coronary intervention (PCI): a systematic review and meta-analysis
Authors' conclusion
Patients undergoing complex PCI have an increased risk of both ischaemic and bleeding events compared with patients undergoing non-complex PCI (PROSPERO: CRD420250656254).
Study context
- Population
- Patients undergoing PCI (complex versus non-complex)patients, of whom 94,633 (33%) underwent complex PCI
- Participants
- 290,039 patients
- Comparison
- Complex versus non-complex PCI
- Complex PCIn = 94,633
- Outcome
- Myocardial infarction and major bleeding
Methodological detailsrandom-effects model within a Bayesian framework, Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for prognostic studies
- Random-effects model within a Bayesian framework
- GRADE framework for prognostic studies
Pooled result
As reported in the abstract
complex PCI vs non-complex PCIAdjusted hazard ratio (95% CrI)
Myocardial infarction; credible interval (CrI)
1.71(1.49–1.96)
Major bleeding; credible interval (CrI)
1.24(1.14–1.35)
Further pooled results
| Outcome | Adjusted HR (95% CrI) | |
|---|---|---|
| Secondary outcomesComplex PCIvs non-complex PCIAll-cause death; CrI | 1.21 (1.12–1.32) | |
| Secondary outcomesComplex PCIvs non-complex PCICardiovascular death; CrI | 1.29 (1.15–1.46) | |
| Secondary outcomesComplex PCIvs non-complex PCIStent thrombosis; CrI | 1.76 (1.49–2.14) | |
| Secondary outcomesComplex PCIvs non-complex PCITarget lesion or vessel revascularisation; CrI | 1.99 (1.58–2.50) | |
| Secondary outcomesComplex PCIvs non-complex PCIStroke; CrI | 1.21 (1.03–1.42) | |
| 0.512Adjusted hazard ratio (log scale) |
Posterior probability and certainty of evidence
- Posterior probability of a higher risk associated with complex versus non-complex PCI, all study outcomes
- >99%
- Certainty of evidence moderate to high for all outcomes except stroke (low certainty)
- Secondary analysis, including unadjusted risk estimates, provided consistent results
Original publication
Ischaemic and bleeding events after complex versus non-complex PCI: a systematic review and meta-analysis. EuroIntervention. Published 6 April 2026. doi:10.
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