Patients undergoing complex percutaneous coronary intervention (PCI) remain at elevated risk for adverse ischemic outcomes despite advances in procedural techniques and secondary prevention strategies. An analysis from the South-East Netherlands Heart Registry, presented at EuroPCR 2026, evaluated 1-year outcomes across complex PCI subtypes in contemporary clinical practice.
The South-East Netherlands Heart Registry (ZON-HR) is an ongoing multicenter PCI registry collecting patient demographics, procedural characteristics, laboratory data, medication use, and clinical outcomes. The present analysis included patients with completed a 1-year follow-up and excluded procedures involving two or more complex PCI features.
Complex PCI was defined as PCI involving chronic total occlusion (CTO), bifurcation lesions treated with two stents, venous graft PCI, or a total stent length of at least 60 mm.
Findings
- A total of 1,847 patients underwent complex PCI, and 6,796 underwent non-complex PCI.
- Complex PCI was associated with a 1.63-fold higher risk of major adverse cardiovascular and cerebrovascular events at 1 year compared with non-complex PCI (p < 0.01).
- The increased ischemic risk after complex PCI was primarily driven by myocardial infarction and unplanned revascularization.
- After multivariable adjustment, myocardial infarction risk remained significantly higher in the complex PCI group (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.03-2.24).
- Among complex PCI subtypes, bifurcation PCI independently predicted higher myocardial infarction risk (HR, 2.75; 95% CI, 1.33-5.68).
- No significant adjusted differences in outcomes were observed for CTO PCI, venous graft PCI, or PCI involving a total stent length of at least 60 mm.
Complex PCI remained associated with higher ischemic risk at 1 year compared with non-complex PCI, particularly among patients undergoing bifurcation stenting. The findings support more tailored secondary prevention and risk stratification strategies after complex PCI.
