After PCI, What Matters Most? Heart Failure, Bleeding, or Recurrent MI? | JACC Baran

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, and Nobuhiro Ikemura welcome Dr. Takahiro Suzuki, MD to discuss his JACC: Cardiovascular Interventions study, “Nonfatal Adverse Events and Risk for Subsequent Mortality in Patients Undergoing Percutaneous Coronary Intervention.” Using the multicenter Japanese JCD-KiCS PCI registry, the study examined how post-PCI nonfatal events—including heart failure hospitalization, recurrent acute coronary syndrome, and major bleeding—shape subsequent mortality risk. Among more than 10,000 patients undergoing PCI, heart failure hospitalization emerged as the most frequent adverse event and carried the strongest association with subsequent mortality, with a population attributable fraction suggesting it accounted for nearly one-fifth of the overall mortality burden after PCI. The episode explores why PCI follow-up may need to move beyond the traditional “ischemia versus bleeding” framework, how heart failure surveillance could become central to post-PCI care, and why endpoint design in cardiovascular trials may need to better reflect the unequal clinical weight of different adverse events.