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Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention
Sabato Sorrentino1,2, Usman Baber1, Bimmer E Claessen1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Insights
Bleeding determinants (BDs) are common in patients undergoing percutaneous coronary intervention (PCI), increasing the risk of post-discharge bleeding (PDB) and adverse cardiovascular events. Anaemia, oral anticoagulants, and malignancy are key predictors of PDB.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Bleeding determinants (BDs) are known risk factors for adverse events.
- Their prevalence and predictive value in real-world percutaneous coronary intervention (PCI) patients are not well-established.
- This study characterizes BDs in a large cohort undergoing PCI with stent implantation.
Purpose of the Study:
- To determine the occurrence and predictive value of bleeding determinants (BDs) in patients undergoing percutaneous coronary intervention (PCI).
- To analyze the association between BDs and post-discharge bleeding (PDB) and other adverse events.
- To identify independent predictors of PDB in the real-world setting.
Main Methods:
- Retrospective analysis of 10,406 patients undergoing coronary stenting from January 2012 to December 2016.
- Definition of post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion.
- Analysis of pre-specified BDs using PARIS bleeding and PRECISE-DAPT scores, and LEADERS FREE trial criteria.
Main Results:
- 28.2% of patients had one BD, 22.8% had two, and 28.0% had three or more BDs.
- One-year PDB occurred in 2.4% of patients, increasing with the number of BDs (1.12% to 4.35%).
- Independent predictors of 1-year PDB included anemia, oral anticoagulants at discharge, and malignancy.
Conclusions:
- Numerous risk factors contribute to post-discharge bleeding (PDB) after PCI.
- These bleeding determinants (BDs) often coexist and confer an additive risk.
- Identifying and managing BDs is crucial for reducing PDB and improving patient outcomes.
Background:
Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre.
Methods:
We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed.
Results:
In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk.
Conclusion:
Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.
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