Prevalence and Impact of High Bleeding Risk in Patients Undergoing Left Main Artery Disease PCI

Mauro Chiarito, Annapoorna Kini, Anastasios Roumeliotis, Davide Cao, David Power, Samantha Sartori, Adam Reisman, Zhongjie Zhang, Tafadzwa Mtisi, Johny Nicolas, Matteo Nardin, Giulio Stefanini, Usman Baber, Gennaro Giustino, Joseph Sweeny, Roxana Mehran, Samin Sharma, George Dangas

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI). Background: LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated. Methods: All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months. Results: Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment. Conclusions: Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.

Original languageEnglish
Pages (from-to)2447-2457
Number of pages11
JournalJACC: Cardiovascular Interventions
Issue number22
StatePublished - 22 Nov 2021


  • drug-eluting stent(s)
  • high bleeding risk
  • left main coronary artery
  • percutaneous coronary intervention


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