# The impact of heart failure and bleeding risk on clinical outcomes in patients after percutaneous coronary intervention

## TL;DR

Heart failure and high bleeding risk increase the chances of poor outcomes after heart procedures like PCI, requiring more careful patient management.

## Contribution

This study identifies the independent impact of heart failure and high bleeding risk on adverse outcomes after PCI using a large registry.

## Key findings

- Heart failure patients had a 1.59 times higher risk of MACCE after PCI compared to non-HF patients.
- Heart failure patients had a 1.74 times higher risk of major bleeding after PCI compared to non-HF patients.
- High bleeding risk was strongly associated with both MACCE and bleeding, regardless of heart failure status.

## Abstract

In recent years, revascularization for ischaemic heart failure (HF) has received increasing attention, and percutaneous coronary intervention (PCI) has been positioned as a high-risk procedure. However, the risk of major bleeding and major adverse cardiac and cerebrovascular events (MACCE) after PCI for patients with ischaemic HF has not been adequately evaluated.

HF patients were selected from the PENDULUM (Platelet rEactivity in patieNts with DrUg eLUting stent and balancing risk of bleeding and ischaemic event) registry to compare the efficacy and safety of PCI in HF and non-HF patients. In addition, the impact of high bleeding risk (HBR) defined as BARC 3 and 5 was evaluated in these patients.

A total of 6266 patients were included; 16% (n = 1006) had a history of HF at enrolment. Patients with HF showed a higher MACCE rate than those without HF (18.4% versus 7.7%; adjusted hazard ratio [HR] = 1.59, 95%CI, 1.30–1.93; p < 0.001) and a significant difference in major bleeding (9.3% versus 3.3%; adjusted HR = 1.74, 95%CI, 1.30–2.33; p < 0.001). HBR was significantly more associated with the MACCE and major bleeding rates than non-HBR, regardless of HF status (adjusted HR = 2.93, 95% CI: 2.33–3.69, p < 0.001, p for interaction = 0.913, adjusted HR = 2.67, 95% CI: 1.89–3.76, p < 0.001, p for interaction = 0.465, respectively).

After contemporary PCI, HF and HBR were independently associated with a higher risk of MACCE and bleeding. HF patients after PCI require more careful management to improve prognosis, particularly with HBR factors.

The online version contains supplementary material available at 10.1186/s12872-025-05429-6.