Predictors of bleeding-related in-hospital complications after coronary angiography and percutaneous coronary intervention: A single-center retrospective cohort study in Iran

Background: Coronary angiography (CA) and percutaneous coronary intervention (PCI) are widely used for diagnosing and treating coronary artery disease (CAD) but may cause bleeding-related in-hospital complications, especially with femoral access. This study evaluated the incidence and predictors of access-site bleeding events and related outcomes in central Iran. Methods: In this retrospective cohort, 1369 patients underwent CA and PCI at Afshar Hospital, Yazd, between 2020 and 2022. Demographic, clinical, and procedural data were collected. Bleeding events were classified using the Bleeding Academic Research Consortium (BARC) criteria, and high bleeding risk was defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR). Logistic regression identified independent predictors. Results: Bleeding-related in-hospital complications occurred in 143 patients (10.4%), most commonly inguinal hematoma (8.4%), major bleeding (1.6%), and mortality (0.6%). BARC Type 2 bleeding was most frequent (8.4%), followed by Type 3a (1.6%) and 3b (0.3%). Based on ARC-HBR, 13.5% of patients met at least one major or two minor high bleeding risk criteria. Multivariate analysis showed that elevated international normalized ratio (INR) (OR = 2.15; 95% CI: 1.22-3.72; P = 0.006) and anticoagulant use (OR = 1.8; 95% CI: 1.14-2.85; P = 0.011) were significantly associated with complications. Conclusion: Bleeding-related complications, particularly hematoma, major bleeding, and procedure-related mortality, occurred in over 10% of patients undergoing CA and PCI. Anticoagulant therapy and elevated INR were key predictors, highlighting the importance of individualized risk assessment and bleeding risk stratification using tools like BARC and ARC-HBR.