Clinical Impact of Angiographic Complications Occurring During Percutaneous Coronary Interventions

Background: The clinical impact of different types of angiographic complications during elective PCIs remains largely unexplored. Aims: To explore the incidence, management, and outcomes of angiographic complications by type and severity during non-urgent, non-CTO PCIs. Methods: Clinical and procedural characteristics were prospectively collected and entered in a catheterization laboratory database, including a section dedicated to PCI complications, from 2015 to 2024. Angiographic complications were classified in eight categories: dissections, perforations, device entrapment/fracture, side branch flow impairment, vessel thrombosis, distal embolization, and any temporary or persistent slow-flow or total occlusion. 30-days and 1-year all-cause mortality were compared between two cohorts with or without angiographic complications, after a propensity score matching for demographic, clinical, procedural and anatomical characteristics. Results: Out of 8401 non-urgent PCIs, 420 (5.0%) presented ≥ 1 angiographic complication (417 patients), with the following incidences: 2.2% iatrogenic dissections, 1.2% side branch flow impairment, 1.2% slow flow, 1.0% vessel occlusion, 0.4% distal embolization, 0.4% vessel thrombosis, 0.4% perforations, 0.1% device entrapment/fracture. Patients with angiographic complications showed a significantly higher risk of 30-days mortality compared to the propensity score-matched cohort without angiographic complications (4.1% vs. 1.6%, p = 0.045). Age, a previous hospitalization for decompensated heart failure, and a procedure on severely calcified lesions were independently associated with 1-year mortality in patients with angiographic complications. Conclusion: Angiographic complications during elective PCI significantly increase 30-day mortality compared with uncomplicated PCI. A history of decompensated heart failure warrants particular caution in the event of angiographic complications, as it is associated with an increased risk of mortality within the first year after the procedure.