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Prevalence and Impact of High Bleeding Risk in Patients Undergoing Left Main Artery Disease PCI
Mauro Chiarito1, Annapoorna Kini2, Anastasios Roumeliotis2
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy.
Insights
Patients with high bleeding risk (HBR) undergoing left main percutaneous coronary intervention (LM PCI) face significantly higher risks of death, myocardial infarction, and bleeding. However, rates of revascularization and stent thrombosis remain comparable, indicating frailty and comorbidities drive adverse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Left main percutaneous coronary intervention (LM PCI) is performed in high-risk patients.
- High bleeding risk (HBR) patients constitute a significant subgroup undergoing LM PCI.
- Outcomes for HBR patients after LM PCI are not well-established.
Purpose of the Study:
- To determine the prevalence of HBR in patients undergoing LM PCI.
- To evaluate the prognostic impact of HBR on clinical outcomes after LM PCI.
Main Methods:
- Prospective enrollment of 619 patients undergoing LM PCI (2014-2017).
- HBR defined by Academic Research Consortium criteria (≥1 major or ≥2 minor criteria).
- Primary endpoint: composite of all-cause death, myocardial infarction (MI), or stroke at 12 months.
Main Results:
- 55.3% of patients had HBR.
- HBR patients had a 4-fold higher rate of the primary endpoint (20.5% vs. 4.9%) compared to non-HBR patients.
- Increased risks of all-cause death and MI were observed in HBR patients; bleeding rates were also higher.
Conclusions:
- HBR is prevalent in LM PCI patients and is associated with increased risks of death, MI, and bleeding.
- Comparable rates of revascularization and stent thrombosis suggest non-procedural factors like frailty contribute to worse outcomes.
- Risk stratification for HBR is crucial in LM PCI patient management.
Objectives:
The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI).
Background:
LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated.
Methods:
All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months.
Results:
Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment.
Conclusions:
Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.
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