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Effect of Bleeding Risk on Type of Stent Used in Patients Presenting With Acute Coronary Syndrome.

by Alraies, M Chadi; Lee, Sang Yeub; Lipinski, Michael J; Buchanan, Kyle; Steinvil, Arie; Rogers, Toby; Koifman, Edward; Gai, Jiaxiang; Torguson, Rebecca; Ben-Dor, Itsik; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: American Journal of Cardiology. 120(8):1272-1278, 2017 Oct 15.Journal: The American journal of cardiology.Published: 2017ISSN: 0002-9149.Full author list: Alraies MC; Lee SY; Lipinski MJ; Buchanan K; Steinvil A; Rogers T; Koifman E; Gai J; Torguson R; Ben-Dor I; Satler LF; Pichard AD; Waksman R.UI/PMID: 28826893.Subject(s): Acute Coronary Syndrome/di [Diagnosis] | *Acute Coronary Syndrome/su [Surgery] | Aged | District of Columbia/ep [Epidemiology] | *Drug-Eluting Stents/ae [Adverse Effects] | Female | Follow-Up Studies | Humans | Incidence | Male | Middle Aged | Percutaneous Coronary Intervention/ae [Adverse Effects] | *Percutaneous Coronary Intervention/mt [Methods] | Postoperative Hemorrhage/ep [Epidemiology] | *Postoperative Hemorrhage/et [Etiology] | Prosthesis Failure | Retrospective Studies | *Risk Assessment/mt [Methods] | Risk Factors | Time FactorsInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.amjcard.2017.07.013 (Click here) Abbreviated citation: Am J Cardiol. 120(8):1272-1278, 2017 Oct 15.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Patients at high bleeding risk (HBR) are at increased risk of bleeding following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) due to the need for longer dual antiplatelet duration. We sought to evaluate the likelihood of receiving DES during PCI in HBR populations and to characterize DES utilization trends over time. Consecutive patients who underwent PCI from April 2003 to September 2015 were identified. HBR is defined as patients fulfilling 1 or more of the HBR criteria: age >=75 years, anticoagulation use at discharge, history of stroke, cancer in previous 3 years, glucocorticoid use, hemoglobin (Hgb)<11g/dl, platelet count <100,000/mm<sup>3</sup>, or creatinine clearance (CCr)<40ml/min. Multivariate analysis was performed to identify which variables predicted DES selection. There were 10,594 patients (41.6%) who the met HBR definition. When adjusting for known risk factors, HBR patients were less likely to receive a DES compared with non-HBR patients (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.54 to 0.62, p<0.001). A preprocedural Hgb <11g/dl had the greatest association with choosing DES during PCI (OR 0.51, 95% CI 0.45 to 0.57, p<0.001). Within the HBR patients, having 3 or more HBR criteria versus <3 HBR criteria had lower likelihood of receiving a DES (OR 0.50, 95% CI 0.44 to 0.57, p<0.001). In conclusion, presence of HBR has a significant impact upon the decision to use DES. Copyright (c) 2017 Elsevier Inc. All rights reserved.

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