Comparative influence of bleeding and ischemic risk factors on diabetic patients undergoing percutaneous coronary intervention with everolimus‐eluting stents

Autor: Anastasios Roumeliotis, Sripal Bangalore, Ashok Seth, Marco Valgimigli, Ridhima Goel, Deepak L. Bhatt, Rishi Chandiramani, Moritz Blum, Junbo Ge, Franz-Josef Neumann, Lijuan Wang, Giulio G. Stefanini, James B. Hermiller, Roxana Mehran, Dominick J. Angiolillo, Davide Cao, Ken Kozuma, Kai Koo, Rajendra M Makkar, Mitchell W. Krucoff, Shigeru Saito
Přispěvatelé: University of Zurich, Mehran, Roxana
Rok vydání: 2020
Předmět:
Acute coronary syndrome
medicine.medical_specialty
medicine.medical_treatment
Population
Hemorrhage
610 Medicine & health
Coronary Artery Disease
030204 cardiovascular system & hematology
11171 Cardiocentro Ticino
2705 Cardiology and Cardiovascular Medicine
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
Diabetes Mellitus
Humans
2741 Radiology
Nuclear Medicine and Imaging
Medicine
Radiology
Nuclear Medicine and imaging
Everolimus
030212 general & internal medicine
Myocardial infarction
education
Stroke
Aged
education.field_of_study
business.industry
Percutaneous coronary intervention
Stent
Drug-Eluting Stents
General Medicine
medicine.disease
Treatment Outcome
Conventional PCI
Cardiology
Stents
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Mace
Zdroj: Catheterization and Cardiovascular Interventions. 98:1111-1119
ISSN: 1522-726X
1522-1946
Popis: Objective To investigate the impact of ischemic and bleeding risk factors on long-term clinical outcomes of patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents. Background Second-generation drug-eluting stents have substantially improved outcomes after PCI in the general population; however, DM patients continue to experience high rates of ischemic and bleeding complications. Methods DM patients from the pooled XIENCE V registry were divided into high or low bleeding and ischemic risk groups (HBR, LBR, HIR, and LIR) based on established bleeding (age ≥ 75 years; chronic kidney disease; anemia; prior stroke; oral anticoagulation; thrombocytopenia; prior major bleeding) and ischemic (acute coronary syndrome; prior myocardial infarction [MI]; ≥3 stents implanted; ≥3 vessels treated; ≥3 lesions treated; stent length > 60 mm; bifurcation treated with ≥2 stents; chronic total occlusion) risk factors. The primary outcomes were major adverse cardiac events (MACE; cardiac death, MI, or stent thrombosis) and major bleeding at 4-year follow-up. Results A total of 3,704 DM patients were divided into four groups (21.5% LBR/LIR; 39.0% LBR/HIR; 15.6% HBR/LIR; 23.9% HBR/HIR). Compared with LBR/LIR patients, those at HBR/HIR and HBR/LIR had a significantly higher risk of MACE (HR (95% CI) 2.7 (1.9-3.9) and 2.2 (1.5-3.2), respectively) and major bleeding (2.7 (1.6-4.8) and 2.6 (1.4-4.7), respectively), while LBR/HIR patients did not. Conclusions Among DM patients undergoing PCI, presence of bleeding risk factors was associated with a higher risk of both ischemic and bleeding events, whereas commonly used features of ischemic risk did not impact long-term clinical outcomes.
Databáze: OpenAIRE
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