The combination of complex percutaneous coronary intervention (PCI) in patients with comorbidities and complicated heart disease defines a complex high risk and indicated patient (CHIP). Complex PCI refers to the percutaneous treatment involving at least one of the following characteristics: 3 vessels treated, ≥3 lesions treated, total stent length >60 mm, bifurcation with 2 stents implanted, use of any atherectomy device, left main as target vessel, surgical bypass graft or chronic total occlusion as target lesions. Percutaneous treatment of CHIP confers an increased risk of complications. CHIP-PCI is often performed in high bleeding risk patients. Conversely, major criteria for HBR include several comorbidities that also define a CHIP. Dual antiplatelet therapy (DAPT) is the mainstay treatment after PCI but also the main cause of bleeding. Strategies to reduce bleeding risk after CHIP-PCI may include shortening the duration of DAPT regime, de-escalation strategies and improvement of procedural outcomes with the help of co-adjuvant techniques such as intravascular imaging and the development in each centre of a specialized team of interventionalists with adequate cognitive and technical skills to manage these patients and anatomies. DAPT regime must be individualized according to the residual ischaemic risk and the components of the HBR score.