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Predictors and consequences of postdischarge gastrointestinal bleeding after percutaneous coronary intervention
Pei Zhu1, Xiaofang Tang1, Jingjing Xu1
1Department of cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Insights
Postdischarge gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) did not increase major adverse cardiovascular events (MACCE) but led to dual antiplatelet therapy (DAPT) cessation, which significantly increased mortality.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Research
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Gastrointestinal bleeding (GIB) is a potential complication following PCI.
- Understanding the impact of postdischarge GIB is crucial for patient management.
Purpose of the Study:
- To determine the incidence, predictors, and outcomes of postdischarge GIB in patients who underwent PCI.
- To evaluate the association between GIB and major adverse cardiovascular and cerebrovascular events (MACCE).
- To assess the relationship between GIB, dual antiplatelet therapy (DAPT) cessation, and mortality.
Main Methods:
- A 2-year follow-up study of 10,637 consecutive patients undergoing PCI in 2013.
- Multivariable Cox proportional hazards regression was used to identify predictors of GIB and MACCE.
- Analysis of postdischarge GIB events, MACCE, DAPT cessation, and 2-year mortality.
Main Results:
- Postdischarge GIB occurred in 1.1% of patients, with predictors including renal dysfunction and ticagrelor use.
- No significant association was found between postdischarge GIB and MACCE (7.3% vs 12.0%, P = .092).
- DAPT cessation occurred in 2.91% of patients and was strongly associated with 2-year mortality (21.6% vs 0.4%, P < .001).
Conclusions:
- Postdischarge GIB after PCI is not significantly associated with MACCE up to 2 years.
- GIB increases the likelihood of DAPT cessation.
- DAPT cessation is a strong predictor of increased 2-year mortality in patients post-PCI.
Aim:
To evaluate the incidence, predictors, and outcomes of postdischarge gastrointestinal bleeding (GIB) in patients underwent percutaneous coronary intervention (PCI) in a 2-year follow-up study.
Methods And Results:
All consecutive patients who underwent PCI throughout 2013 were enrolled. Multivariable cox proportional hazards regression were used to identify predictors of postdischarge GIB and 2-year major adverse cardiovascular and cerebrovascular events (MACCE). Among 10 637 enrolled patients, postdischarge GIB events occurred in 123 (1.1%) patients at a median time of 329 days (interquartile range: 191-504 days). Predictor of postdischarge GIB included renal dysfunction and use of ticagrelor. There was no significant association between postdischarge GIB and MACCE (7.3% vs 12.0%, P = .092). Among whole population, 310 (2.91%) patients had dual antiplatelet therapy (DAPT) cessation. DAPT cessation was strongly associated with 2-year mortality (21.6% vs 0.4%, P < .001).
Conclusion:
In this large cohort of real-world patients after PCI, postdischarge GIB was not significantly associated with MACCE up to 2 years of follow-up but lead to an increase in DAPT cessation, and DAPT cessation was strongly associated with 2-year mortality.
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