A MAJOR new study has revealed that not all complications following percutaneous coronary intervention (PCI) carry equal weight, with heart failure hospitalisation (HFH) emerging as the strongest predictor of subsequent death.
PCI, a widely used procedure to restore blood flow in patients with coronary artery disease, is generally considered safe. However, adverse events after PCI remain common and are often grouped together in clinical trials and guidelines, despite potentially differing impacts on long-term outcomes.
Researchers analysed data from a large Japanese multicentre registry spanning 2008–2021, including 10,482 patients who underwent PCI and were followed for two years. The study aimed to compare how three key nonfatal adverse events – HFH, acute coronary syndrome (ACS), and major bleeding – were associated with subsequent mortality.
PCI Adverse Events Mortality Risk Not Equal
During follow-up, 9.7% of patients experienced at least one adverse event. The two-year cumulative incidence was highest for HFH at 4.7%, followed by ACS at 3.4% and major bleeding at 2.5%. However, the impact of these events on mortality varied substantially.
HFH was associated with a markedly increased risk of death (adjusted hazard ratio [HR]: 6.11; 95% confidence interval [CI]: 4.76–7.85), far exceeding that of ACS (HR: 3.22; 95% CI: 2.14–4.84) and major bleeding (HR: 2.62; 95% CI: 1.71–4.02). Population-level analysis further showed that HFH accounted for 20.1% of the mortality burden, compared with just 4.3% for ACS and 2.9% for major bleeding.
These findings challenge the long-standing practice of treating post-PCI adverse events as equivalent within composite endpoints.
Implications for PCI Adverse Events Mortality Management
The results showed that HFH following PCI was associated with a substantially higher risk of subsequent mortality compared with other adverse events. In contrast, although ACS and major bleeding remained clinically important, their associations with long-term mortality were less pronounced.
Importantly, the study was observational and based on registry data, meaning causality could not be definitively established. Additionally, the findings were derived from a Japanese population, which may limit generalisability to other healthcare settings.
Nevertheless, the data highlight a critical need to rethink how adverse events are prioritised in both research and clinical care. Greater emphasis on preventing and managing heart failure after PCI could improve survival outcomes, while future trials may need to reconsider how composite endpoints are constructed to better reflect real-world risk.
Reference
Suzuki T et al. Nonfatal adverse events and risk for subsequent mortality in patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv. 2026; DOI:10.1016/j.jcin.2026.02.010.
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