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Percutaneous coronary intervention (PCI) is the most common cardiac invasive procedure to treat patients with coronary artery disease. In the USA, it is estimated that more than one million patients undergo PCI each year. Fearsome complications such as coronary dissection or acute vessel closure in the balloon angioplasty era have been largely mitigated with the introduction of coronary artery stents and the routine use of antiplatelet and antithrombotic therapy. In the contemporary practice of interventional cardiology, it is recognised that bleeding has become the most common early complication associated with PCI. While the incidence of bleeding varies across studies, recent data from the USA found major bleeding occurs at a rate of 1.7% after PCI,1 about half from the site of arterial access and half from non-access locations, most commonly the gastrointestinal (GI) tract.1
As a practising clinician, it is easy to remember situations where a patient has undergone successful PCI and then suffered a major bleeding episode. Treating patients who bled after PCI is often complicated because one needs to consider the appropriate intervention to manage the active bleeding, to weigh the potential benefits and risks of withholding or withdrawing antiplatelet or anticoagulation therapy and to evaluate whether red blood cell transfusion outweighs its potential adverse effects. Indeed, many factors directly relating to the bleeding itself and its management have been implicated to be associated with worse outcomes among patients who experienced bleeding after PCI procedures.2
In this issue of Open Heart, Kwok et al3 make an important contribution to this field, by examining the relationship between bleeding complications in PCI and subsequent death. This comprehensive systematic review is one of the largest to date, with 38 published studies, …
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