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Time-Dependent Associations Between Actionable Bleeding, Coronary Thrombotic Events, and Mortality Following
Usman Baber1, George Dangas1, Jaya Chandrasekhar1
1Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Actionable bleeding (AB) and coronary thrombotic events (CTE) pose similar mortality risks after percutaneous coronary intervention (PCI). These findings aid in balancing risks when considering dual-antiplatelet therapy duration post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The independent impact of actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk following percutaneous coronary intervention (PCI) is not well understood.
- Optimizing dual-antiplatelet therapy (DAPT) duration requires a clear understanding of the risks associated with both bleeding and thrombotic complications.
Purpose of the Study:
- To investigate the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) and their impact on 2-year mortality risk after PCI.
- To compare the magnitude of mortality risk conferred by AB versus CTE in patients undergoing PCI.
Main Methods:
- A post hoc analysis of the PARIS registry, including 5,018 patients who underwent PCI with stent implantation.
- Actionable bleeding (AB) defined as Bleeding Academic Research Consortium type 2 or 3; CTE included definite/probable stent thrombosis or myocardial infarction.
- Extended Cox regression modeling was used to assess the association between time-dependent CTE and AB with 2-year all-cause mortality.
Main Results:
- Over 2 years, cumulative incidences were: CTE 5.9%, AB 8.1%, and all-cause mortality 4.7%.
- Adjusted hazard ratios for mortality were 3.3 for CTE and 3.5 for AB, indicating comparable risks.
- Mortality risk was highest within 30 days post-event and declined thereafter; DAPT status influenced thrombotic event risk but not bleeding-related mortality risk.
Conclusions:
- Both intracoronary thrombosis and actionable bleeding are associated with comparable, significant mortality risks up to 2 years post-PCI.
- These findings are crucial for informing clinical decisions regarding the extension or discontinuation of dual-antiplatelet therapy after PCI.
Objectives:
The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention (PCI).
Background:
The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized.
Methods:
A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 patients undergoing PCI with stent implantation. CTE included definite or probable stent thrombosis or myocardial infarction. AB was defined as Bleeding Academic Research Consortium type 2 or 3. Associations between CTE and AB, both of which were modeled as time-dependent covariates, and 2-year mortality risk were examined using extended Cox regression.
Results:
Over 2 years, the cumulative incidence of CTE, AB, and all-cause mortality was 5.9% (n = 289), 8.1% (n = 391), and 4.7% (n = 227), respectively. Adjusted hazard ratios for mortality associated with CTE and AB were 3.3 (95% confidence interval: 2.2 to 4.9) and 3.5 (95% confidence interval: 2.3 to 5.4), respectively. Temporal gradients in risk after either event were highest in the first 30 days and declined rapidly thereafter. Thrombotic events occurring while patients were on versus off dual-antiplatelet therapy were associated with a higher mortality risk, whereas risk related to AB was not influenced by dual-antiplatelet therapy status at the time of bleeding.
Conclusions:
Intracoronary thrombosis and AB are associated with mortality risks of comparable magnitude over a 2-year period after PCI, findings that might inform risk/benefit calculations for extension versus discontinuation of dual-antiplatelet therapy.