Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries
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Fabrizio D'Ascenzo1, Carloalberto Biolè1, Sergio Raposeiras-Roubin2
1Department of Cardiology, University of Torino, Italy.
Insights
In acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), ischemic and bleeding risks are similar within one year. However, initial risks favor ischemia, while later risks may shift towards bleeding, especially with certain patient profiles.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) can vary.
- Clinical presentation, medical, and interventional strategies influence these risks within the first year post-PCI.
Purpose of the Study:
- To compare the average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI in ACS patients.
- To analyze the difference between ADBR and ADIR to estimate potential excess of bleeding or ischemic events in specific subgroups.
Main Methods:
- Utilized data from two multicenter registries, BleeMACS and RENAMI, which enrolled patients with ACS treated with PCI.
- Included 19,826 patients treated with clopidogrel, prasugrel, or ticagrelor.
- Calculated ADIR and ADBR as primary endpoints for the first year post-PCI.
Main Results:
- Overall, ADBR (0.008085%) and ADIR (0.008017%) were similar in the first year post-PCI (P=.886).
- ADIR was higher than ADBR in the first two weeks (P=.013), particularly in ST-segment elevation myocardial infarction and incomplete revascularization patients.
- Patients with incomplete revascularization showed excess ischemic risk (P=.003), while non-ST-segment elevation ACS and ticagrelor patients had excess bleeding risk (P=.012 and P=.022, respectively).
Conclusions:
- In unselected ACS patients, 1-year ADIR and ADBR post-PCI are comparable.
- ADIR predominates in the early phase (first 2 weeks), especially in STEMI and incomplete revascularization.
- Later, ADBR may exceed ADIR in NSTE-ACS and ticagrelor-treated patients.
Background:
The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies.
Methods:
BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup.
Results:
A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively).
Conclusions:
In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.
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