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Published on: June 12, 2021
Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions
Konstantinos C Koskinas1, Lorenz Räber1, Thomas Zanchin1
1From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
Insights
Gastrointestinal bleeding (GIB) after percutaneous coronary interventions (PCI) significantly increases mortality risk. Triple antithrombotic therapy is a key drug-related predictor of GIB in patients undergoing PCI.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Research
Background:
- Gastrointestinal bleeding (GIB) risks and outcomes post-percutaneous coronary intervention (PCI) are not well-defined with modern drug-eluting stents and potent antiplatelet agents.
- This study investigates GIB in a contemporary PCI cohort using unrestricted drug-eluting stent use.
Purpose of the Study:
- To determine the frequency, predictors, and clinical impact of GIB within one year following PCI.
- To identify patient and treatment-related factors associated with GIB after PCI.
Main Methods:
- Prospective inclusion of consecutive patients undergoing PCI in the Bern PCI Registry (2009-2012).
- Recording of Bleeding Academic Research Consortium (BARC) GIB and cardiovascular outcomes up to 1 year post-PCI.
- Multivariable analysis to identify independent predictors of GIB.
Main Results:
- GIB occurred in 1.04% of 6212 patients within 1 year.
- Most GIB events (70.8%) and severe events (BARC ≥ 3B, 84.4%) occurred more than 30 days post-PCI.
- Increasing age, prior GIB, malignancy, smoking, and triple antithrombotic therapy were independent GIB predictors.
- GIB was associated with significantly increased all-cause mortality (aHR 3.40) and major adverse cardiovascular events (aHR 3.75).
Conclusions:
- Gastrointestinal bleeding significantly worsens prognosis in unselected patients undergoing PCI.
- Triple antithrombotic therapy is a major drug-related risk factor for GIB within one year of PCI, alongside patient-specific factors.
Background:
The risk factors and clinical sequelae of gastrointestinal bleeding (GIB) in the current era of drug-eluting stents, prolonged dual antiplatelet therapy, and potent P2Y12 inhibitors are not well established. We determined the frequency, predictors, and clinical impact of GIB after percutaneous coronary interventions (PCIs) in a contemporary cohort of consecutive patients treated with unrestricted use of drug-eluting stents.
Methods And Results:
Between 2009 and 2012, all consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Bleeding Academic Research Consortium (BARC) GIB and cardiovascular outcomes were recorded within 1 year of follow-up. Among 6212 patients, 84.1% received new-generation drug-eluting stents and 19.5% received prasugrel. At 1 year, GIB had occurred in 65 patients (1.04%); 70.8% of all events and 84.4% of BARC ≥ 3B events were recorded > 30 days after PCI. The majority of events (64.4%) were related to upper GIB with a more delayed time course compared with lower GIB. Increasing age, previous GIB, history of malignancy, smoking, and triple antithrombotic therapy (ie, oral anticoagulation plus dual antiplatelet therapy) were independent predictors of GIB in multivariable analysis. GIB was associated with increased all-cause mortality (adjusted hazard ratio, 3.40; 95% confidence interval, 1.67-6.92; P = 0.001) and the composite of death, myocardial infarction, or stroke (adjusted hazard ratio, 3.75; 95% confidence interval, 1.99-7.07; P < 0.001) and was an independent predictor of all-cause mortality during 1 year.
Conclusions:
Among unselected patients undergoing PCI, GIB has a profound effect on prognosis. Triple antithrombotic therapy emerged as the single drug-related predictor of GIB in addition to patient-related risk factors within 1 year of PCI.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
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