A risk score to predict postdischarge bleeding among acute coronary syndrome patients undergoing percutaneous
Yundai Chen1, Tong Yin1, Shaozhi Xi1
1Department of Cardiology, General Hospital of Chinese People's Liberation Army, Beijing, China.
Insights
Postdischarge bleeding (PDB) after percutaneous coronary intervention (PCI) significantly increases major adverse cardiovascular event (MACE) risk in Chinese acute coronary syndrome (ACS) patients. A new BRIC-ACS score aids in predicting PDB risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Research
Background:
- Dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) balances ischemic event prevention with increased bleeding risk.
- Accurate prediction of postdischarge bleeding (PDB) and its impact on major adverse cardiovascular events (MACE) in real-world settings requires further investigation.
- Understanding these risks is crucial for optimizing patient management after PCI.
Purpose of the Study:
- To evaluate the impact of PDB on MACE occurrence in Chinese patients following PCI.
- To develop and validate a predictive score for PDB risk in this population.
- To compare PDB and MACE risks associated with ticagrelor versus clopidogrel.
Main Methods:
- A cohort of 2496 Chinese acute coronary syndrome (ACS) patients undergoing PCI was prospectively studied.
- One-year follow-up data were collected to assess cumulative incidences of PDB (Bleeding Academic Research Consortium [BARC] ≥2) and MACE.
- A predictive score (BRIC-ACS) was developed based on identified PDB predictors.
Main Results:
- The cumulative incidence of PDB was 4.9% and MACE was 3.3% at 1-year follow-up.
- PDB was significantly associated with a higher risk of postdischarge MACE (adjusted Hazard Ratio: 2.59; p = .02).
- The BRIC-ACS score demonstrated good predictive ability for PDB (C-statistic: 0.67) in the overall cohort.
Conclusions:
- Postdischarge bleeding (BARC ≥2) in Chinese ACS patients undergoing PCI is linked to an increased risk of MACE.
- The developed BRIC-ACS risk score is a valuable tool for identifying patients at high risk of PDB.
- This score is particularly useful for stratifying risk in patients with high ischemic and bleeding potential.
Background:
Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) prevents ischemic events while increasing bleeding risk. Real-world-based metrics to accurately predict postdischarge bleeding (PDB) occurrence and its potential impact on postdischarge major cardiovascular event (MACE) remain undefined. This study sought to evaluate the impact of PDB on MACE occurrence, and to develop a score to predict PDB risk among Chinese acute coronary syndrome (ACS) patients after PCI.
Methods And Results:
From May 2014 to January 2016, 2496 ACS patients who underwent PCI were recruited consecutively from 29 nationally representative Chinese tertiary hospitals. Among 2,381 patients (95.4%, 2,381/2,496) who completed 1-year follow-up, the cumulative incidence of PDB (bleeding academic research consortium type [BARC] ≥2) and postdischarge MACE (a composite of all-cause death, nonfatal myocardial infarction, ischemic stroke, or urgent revascularization) was 4.9% (n = 117) and 3.3% (n = 79), respectively. The association between PDB and MACE during 1-year follow-up, as well as the impact of DAPT with ticagrelor or clopidogrel on PDB were evaluated. PDB was associated with higher risk of postdischarge MACE (7.7 vs. 3.1%; adjusted hazard ratio: 2.59 [95% confidence interval: 1.17-5.74]; p = .02). For ticagrelor versus clopidogrel, PDB risk was higher (8.0 vs. 4.4%; 2.05 [1.17-3.60]; p = .01), while MACE risk was similar (2.0 vs. 3.4%; 0.70 [0.25-1.93]; p = .49). Based on identified PDB predictors, the constructed bleeding risk in real world Chinese acute coronary syndrome patients (BRIC-ACS) score for PDB was established. C-statistic for the score for PDB was 0.67 (95% CI: 0.62-0.73) in the overall cohort, and >0.70 in subgroups with non-ST- and ST-segment elevation myocardial infarction, diabetes and receiving more than two drug eluting stents.
Conclusions:
In Chinese ACS patients, PDB with BARC ≥2 was associated with higher risk for MACE after PCI. The constructed BRIC-ACS risk score provides a useful tool for PDB discrimination, particularly among high ischemic and bleeding risk patients.
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