Revisiting ischemic and bleeding events in high bleeding risk patients after PCI: insights from a Japanese nationwide registry.

Percutaneous coronary intervention (PCI) is performed worldwide, with growing emphasis on reducing bleeding events, particularly in high bleeding risk (HBR) patients like East Asians, despite the potential increase in ischemic risk. Using a Japanese nationwide registry, we investigated ischemic and bleeding event rates to determine the optimal balance based on bleeding risk in real-world practice.We analyzed patient-level data from 105,525 PCI cases across 179 institutions between 2017 and 2018, categorizing patients by HBR scores. Ischemic events (acute myocardial infarction, unstable angina, and stroke) and significant bleeding events requiring emergent care over one year. Adjusted hazard ratios (HRs) were calculated for the mild HBR group (score 1) and the significant HBR groups (score ≥ 2).The mean patient age was 70.4 ± 11.3 with 23.2% female. Ischemic events (2.0%) were numerically more frequently observed than bleeding events (1.3%). Stratified analysis of HBR scores showed higher HBR increased ischemic and bleeding risks: 1.4% vs. 0.8% in non-HBR, 1.8% vs. 1.3% in mild HBR, and 2.7% vs. 1.8% in significant HBR. The HRs for ischemic events in mild and significant HBR groups were 1.22 [95%CI 1.07–1.39] and 1.63 [1.44–1.84], respectively. HRs for bleeding events in the two groups were 1.57 [1.34–1.85] and 2.02 [1.73–2.36], respectively.HBR patients, as expected, exhibited higher incidences of bleeding events at all HBR levels in the contemporary Japanese nationwide registry. Notably, risk of ischemic events remained substantial. Tailored treatment strategies are necessary to achieve an optimal balance between these two serious complications.