Ischemic Versus Bleeding Outcomes After Percutaneous Coronary Interventions in Patients With High Bleeding Risk

Autor: Itsik Ben-Dor, Cheng Zhang, Jaffar M. Khan, Toby Rogers, Ron Waksman, Yuefeng Chen, Lowell F. Satler, Deepakraj Gajanana, Nauman Khalid, Evan Shlofmitz, Anees Musallam, William S. Weintraub, Paul Kolm, Rebecca Torguson, Micaela Iantorno
Rok vydání: 2020
Předmět:
Male
Risk
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
Myocardial Infarction
Psychological intervention
Target vessel revascularization
Hemorrhage
Comorbidity
Coronary Artery Disease
Postoperative Hemorrhage
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Cause of Death
Internal medicine
Myocardial Revascularization
Prevalence
medicine
Humans
In patient
Renal Insufficiency
030212 general & internal medicine
Mortality
Aged
Heart Failure
Aspirin
business.industry
Dual Anti-Platelet Therapy
Percutaneous coronary intervention
Thrombosis
Middle Aged
medicine.disease
Clopidogrel
Heart failure
Cohort
Conventional PCI
Cardiology
Female
Stents
Gastrointestinal Hemorrhage
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Zdroj: The American Journal of Cardiology. 125:1631-1637
ISSN: 0002-9149
Popis: Patients undergoing percutaneous coronary intervention (PCI) often have high-bleeding-risk (HBR) factors. Dual antiplatelet therapy (DAPT) further increases this risk of bleeding. We sought to compare clinical outcomes according to presence or absence of HBR factors in patients with elevated ischemic risk (DAPT score ≥ 2) undergoing PCI. We evaluated all patients undergoing PCI at MedStar Washington Hospital Center (January 2009 to July 2018) with DAPT score ≥2, which is associated with elevated risk of ischemic events. Patients were categorized as HBR group (HBR score ≥1) or low-bleeding-risk (LBR) group (HBR score = 0). Outcomes included major adverse cardiac events such as target vessel revascularization, stent thrombosis, death, and bleeding events at 30 days, 6 months, 1 year, and 2 years. The final cohort consisted of 7,499 patients: 3,949 patients had LBR features, and 3,550 patients had HBR features. The 2 groups were different at baseline, with HBR patients being older and having a higher prevalence of congestive heart failure and renal dysfunction than the LBR group. The mean DAPT score was 2.96±1.1 for the LBR group and 3.7±1.4 for the HBR group (p0.001). During follow-up at 30 days, 6 months, and 1 and 2 years, the rates of target vessel revascularization and stent thrombosis were not significantly different between the 2 groups. Bleeding events and all-cause mortality were significantly more frequent in the HBR group than in the LBR group. In conclusion, patients undergoing PCI often have pre-existing risk factors that predispose them to ischemic and bleeding complications. Prolonged duration of DAPT to mitigate ischemic events could lead to a disproportionate increase in bleeding events, especially in HBR patients.
Databáze: OpenAIRE
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