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Comparative influence of bleeding and ischemic risk factors on diabetic patients undergoing percutaneous coronary
Ridhima Goel1, Davide Cao1,2, Rishi Chandiramani1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
Insights
For patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), bleeding risk factors significantly increase the risk of major adverse cardiac events and bleeding. Ischemic risk factors did not impact long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Mellitus Research
Background:
- Second-generation drug-eluting stents improve outcomes post-percutaneous coronary intervention (PCI).
- However, patients with diabetes mellitus (DM) still face high rates of ischemic and bleeding complications after PCI.
Purpose of the Study:
- To assess the influence of ischemic and bleeding risk factors on long-term clinical outcomes in DM patients undergoing PCI with everolimus-eluting stents.
Main Methods:
- DM patients from the XIENCE V registry were stratified into high or low bleeding and ischemic risk groups.
- Risk stratification used established criteria for bleeding and ischemic factors.
- Primary outcomes included major adverse cardiac events (MACE) and major bleeding at 4-year follow-up.
Main Results:
- 3,704 DM patients were categorized into four groups: low bleeding/low ischemic risk (LBR/LIR), low bleeding/high ischemic risk (LBR/HIR), high bleeding/low ischemic risk (HBR/LIR), and high bleeding/high ischemic risk (HBR/HIR).
- HBR/HIR and HBR/LIR groups showed significantly higher risks of MACE and major bleeding compared to the LBR/LIR group.
- LBR/HIR patients did not exhibit significantly increased risks for these outcomes.
Conclusions:
- Bleeding risk factors in DM patients undergoing PCI are associated with increased risks of both ischemic and bleeding events.
- Traditional indicators of ischemic risk did not significantly affect long-term clinical outcomes in this population.
Objective:
To investigate the impact of ischemic and bleeding risk factors on long-term clinical outcomes of patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents.
Background:
Second-generation drug-eluting stents have substantially improved outcomes after PCI in the general population; however, DM patients continue to experience high rates of ischemic and bleeding complications.
Methods:
DM patients from the pooled XIENCE V registry were divided into high or low bleeding and ischemic risk groups (HBR, LBR, HIR, and LIR) based on established bleeding (age ≥ 75 years; chronic kidney disease; anemia; prior stroke; oral anticoagulation; thrombocytopenia; prior major bleeding) and ischemic (acute coronary syndrome; prior myocardial infarction [MI]; ≥3 stents implanted; ≥3 vessels treated; ≥3 lesions treated; stent length > 60 mm; bifurcation treated with ≥2 stents; chronic total occlusion) risk factors. The primary outcomes were major adverse cardiac events (MACE; cardiac death, MI, or stent thrombosis) and major bleeding at 4-year follow-up.
Results:
A total of 3,704 DM patients were divided into four groups (21.5% LBR/LIR; 39.0% LBR/HIR; 15.6% HBR/LIR; 23.9% HBR/HIR). Compared with LBR/LIR patients, those at HBR/HIR and HBR/LIR had a significantly higher risk of MACE (HR (95% CI) 2.7 (1.9-3.9) and 2.2 (1.5-3.2), respectively) and major bleeding (2.7 (1.6-4.8) and 2.6 (1.4-4.7), respectively), while LBR/HIR patients did not.
Conclusions:
Among DM patients undergoing PCI, presence of bleeding risk factors was associated with a higher risk of both ischemic and bleeding events, whereas commonly used features of ischemic risk did not impact long-term clinical outcomes.
