Ischemic Versus Bleeding Outcomes After Percutaneous Coronary Interventions in Patients With High Bleeding Risk

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Percutaneous coronary intervention (PCI) patients often have high bleeding risk (HBR) factors.
• Dual antiplatelet therapy (DAPT) increases bleeding risk in these patients.
• Elevated ischemic risk, indicated by a DAPT score ≥ 2, necessitates careful management.

Purpose of the Study:

• To compare clinical outcomes in patients undergoing PCI with elevated ischemic risk (DAPT score ≥ 2).
• To evaluate outcomes based on the presence or absence of high bleeding risk (HBR) factors.
• To assess the trade-off between ischemic event prevention and bleeding complications.

Main Methods:

• Retrospective analysis of 7,499 patients undergoing PCI with a DAPT score ≥ 2.
• Categorization into high bleeding risk (HBR score ≥ 1) and low bleeding risk (LBR score = 0) groups.
• Follow-up for major adverse cardiac and bleeding events at 30 days, 6 months, 1 year, and 2 years.

Main Results:

• No significant difference in target vessel revascularization or stent thrombosis between HBR and LBR groups.
• Significantly higher rates of bleeding events and all-cause mortality in the HBR group.
• HBR patients were older with higher prevalence of heart failure and renal dysfunction.

Conclusions:

• Patients undergoing PCI with elevated ischemic risk and HBR factors experience disproportionately more bleeding events with DAPT.
• The findings suggest a need for tailored DAPT strategies in HBR patients to balance ischemic and bleeding risks.
• Risk stratification for both ischemic and bleeding complications is crucial in PCI management.