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The Academic Research Consortium High Bleeding Risk (ARC\u2010HBR) criteria provide a standardized framework for identifying this population, yet optimal PCI timing, procedural strategies, and antithrombotic regimens remain uncertain. This review synthesizes data from randomized controlled trials, large\u2010scale registries, and meta\u2010analyses involving HBR patients undergoing PCI in settings including stable coronary artery disease, acute coronary syndromes (ACS), ST\u2010elevation myocardial infarction (STEMI), post\u2010resuscitation states, and malignancy\u2010related thrombocytopenia. Special emphasis is placed on procedural approaches (radial vs. femoral access), device selection (drug\u2010coated balloons, polymer\u2010free drug\u2010eluting stents), and dual antiplatelet therapy (DAPT) duration. Evidence supports the safety of abbreviated DAPT regimens (1\u20133 months) when combined with bleeding\u2010sparing techniques and devices, with the greatest benefit observed in patients with a high ischemic burden (e.g., GRACE score &gt;\u2009140). Early invasive management in ACS has been associated with reduced ischemic endpoints and shorter hospital stays without a significant rise in major bleeding. Conversely, delayed PCI is advisable in the presence of active bleeding, recent thrombolysis, or severe coagulopathy. Persistent limitations include underrepresentation of ARC\u2010HBR patients in trials and lack of standardized, bleeding risk\u2013tailored timing protocols. PCI in HBR patients can be performed safely and effectively when guided by individualized, evidence\u2010based strategies for procedural timing and antithrombotic therapy. Future directions include integrating biomarker\u2010driven DAPT modulation and artificial intelligence\u2010based decision frameworks to optimize outcomes in this high\u2010risk group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70410","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:26:07Z","timestamp":1765344367000},"page":"780-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reassessing PCI Timing in High Bleeding Risk Patients: Evidence, Strategies, and Outcomes"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5122-8200","authenticated-orcid":false,"given":"Ameer","family":"Awashra","sequence":"first","affiliation":[{"name":"Department of Medicine An Najah National University Nablus 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