Incidence, Prediction, and Outcomes of Major Bleeding After Percutaneous Coronary Intervention in Chinese Patients
Andrew Kei-Yan Ng1, Pauline Yeung Ng2,3, April Ip3
1Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China.
Insights
Late major bleeding (MB) after percutaneous coronary intervention (PCI) significantly increases mortality and adverse cardiac events in Chinese patients. The CARDIAC score effectively predicts this bleeding risk, aiding in prevention strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Patterns of late major bleeding (MB) following percutaneous coronary intervention (PCI) are not well-defined in Chinese populations.
- Understanding these patterns is crucial for optimizing patient care and outcomes.
Purpose of the Study:
- To investigate the incidence, predictive factors, and long-term consequences of late MB in Chinese patients undergoing PCI.
- To evaluate the efficacy of the CARDIAC score in predicting late MB.
Main Methods:
- A retrospective cohort study involving 32,057 patients from 14 Hong Kong hospitals undergoing first-time PCI.
- Patients were stratified based on the occurrence of MB between 30 and 365 days post-PCI.
- Primary endpoint was all-cause mortality; secondary endpoints included major adverse cardiac events (MACE).
Main Results:
- Late MB was independently associated with a significantly higher risk of 5-year all-cause mortality (HR: 2.15) and MACE (HR: 1.57).
- Increased risks of myocardial infarction (HR: 1.25) and stroke (HR: 1.38) were also observed in patients with late MB.
- The CARDIAC score demonstrated good predictive power for MB within 365 days (AUC: 0.76).
Conclusions:
- Late MB after PCI is a significant independent predictor of long-term mortality and adverse cardiovascular events in Chinese patients.
- The CARDIAC score serves as a practical tool for predicting MB post-PCI.
- Preventing late MB is essential for improving cardiovascular outcomes in patients undergoing PCI.
Background:
The patterns of late major bleeding (MB) after percutaneous coronary intervention (PCI) remain unknown in Chinese patients.
Objectives:
This study sought to determine the incidence, prediction, and long-term outcomes of late MB in Chinese patients.
Methods:
This was a retrospective cohort study from 14 hospitals in Hong Kong. Participants were patients undergoing first-time PCI without MB within 30 days or death within 1 year. Patients were stratified by the presence of late MB, defined as MB between 30 and 365 days. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac events (MACE).
Results:
A total of 32,057 patients were analyzed. After adjustment for baseline characteristics, periprocedural characteristics, and medications on discharge, the risks of all-cause mortality at 5 years were significantly higher with late MB (HR: 2.15; 95% CI: 1.92-2.41; P < 0.001). Late MB was also associated with a higher risk of MACE (HR: 1.57; 95% CI: 1.03-1.50; P < 0.001), myocardial infarction (HR: 1.25; 95% CI: 1.04-1.52; P = 0.02), and stroke (HR: 1.38; 95% CI: 1.09-1.73; P = 0.006). The CARDIAC (anti-Coagulation therapy, Age, Renal insufficiency, Drop In hemoglobin, baseline Anemia in Chinese patients) score had a good discriminating power for prediction of MB within 365 days (area under the receiver-operating characteristic curve: 0.76).
Conclusions:
Late MB was independently associated with a higher risk of mortality, MACE, myocardial infarction, and stroke in patients undergoing PCI. The CARDIAC score is a simple model that can predict MB after PCI. Prevention of MB represents an important strategy to optimize cardiovascular outcomes for patients undergoing PCI.
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