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

MedStar author(s):
Citation: American Journal of Cardiology. 125(11):1631-1637, 2020 06 01.PMID: 32273057Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aspirin/tu [Therapeutic Use] | *Clopidogrel/tu [Therapeutic Use] | *Coronary Artery Disease/th [Therapy] | *Hemorrhage/ep [Epidemiology] | *Myocardial Revascularization/sn [Statistics & Numerical Data] | *Percutaneous Coronary Intervention | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | *Thrombosis/ep [Epidemiology] | Aged | Cause of Death | Comorbidity | Dual Anti-Platelet Therapy/ae [Adverse Effects] | Dual Anti-Platelet Therapy/mt [Methods] | Female | Gastrointestinal Hemorrhage/ep [Epidemiology] | Heart Failure/ep [Epidemiology] | Humans | Male | Middle Aged | Mortality | Myocardial Infarction/ep [Epidemiology] | Postoperative Hemorrhage/ep [Epidemiology] | Prevalence | Renal Insufficiency/ep [Epidemiology] | Risk | Risk Assessment | StentsYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: 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 (p <0.001). 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. Copyright (c) 2020 Elsevier Inc. All rights reserved.All authors: Ben-Dor I, Chen Y, Gajanana D, Iantorno M, Khalid N, Khan JM, Kolm P, Musallam A, Rogers T, Satler LF, Shlofmitz E, Torguson R, Waksman R, Weintraub WS, Zhang COriginally published: American Journal of Cardiology. 125(11):1631-1637, 2020 Jun 01.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32273057 Available 32273057

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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 (p <0.001). 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. Copyright (c) 2020 Elsevier Inc. All rights reserved.

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