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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
High bleeding risk in patients undergoing percutaneous coronary intervention with drug-eluting stent implantation:
Nicole D van Hemert1, Pieter R Stella1, Rik Rozemeijer1
1Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
High bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) had higher long-term target-lesion failure rates. Bleeding events did not significantly differ between HBR and non-HBR groups, regardless of dual antiplatelet therapy (DAPT) duration.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- High bleeding risk (HBR) is a significant concern in patients undergoing percutaneous coronary intervention (PCI).
- Identifying and managing HBR patients is crucial for optimizing clinical outcomes.
- The ReCre8 trial investigated stent performance and DAPT duration in PCI patients.
Purpose of the Study:
- To determine the prevalence of HBR in an all-comers PCI cohort.
- To assess the impact of HBR on clinical events, including target-lesion failure (TLF) and bleeding.
- To evaluate the effect of dual antiplatelet therapy (DAPT) duration on outcomes in HBR patients.
Main Methods:
- Analysis of 1488 patients from the ReCre8 trial undergoing PCI.
- Stratification of patients into HBR and non-HBR groups using Academic Research Consortium for High Bleeding Risk criteria.
- Evaluation of clinical outcomes, including TLF and Bleeding Academic Research Consortium (BARC) bleeding events, at one and three years.
Main Results:
- 27.3% of patients were identified as HBR.
- HBR patients showed similar TLF at one year but higher TLF at three years (13.3% vs. 9.1%) compared to non-HBR patients.
- No significant difference in BARC 3-5 bleeding, but higher BARC 2-5 bleeding in HBR patients at three years (4.9% vs. 3.0%).
Conclusions:
- HBR is prevalent in PCI patients and associated with increased long-term TLF.
- DAPT duration did not significantly impact ischemic or bleeding outcomes in HBR patients.
- Treatment strategies for HBR patients undergoing PCI require careful consideration due to long-term risks.
Objectives:
In an all-comers cohort undergoing percutaneous coronary intervention (PCI), we aimed to assess prevalence of high bleeding risk (HBR) patients and impact of HBR and dual antiplatelet therapy (DAPT) on clinical events.
Background:
HBR represents a complex subgroup of patients undergoing PCI.
Methods:
In the ReCre8 trial, patients undergoing PCI were stratified for troponin status and diabetes and randomized to a permanent polymer zotarolimus-eluting- or polymer-free amphilimus-eluting stent. Patients were treated with 12 months (troponin-positive) or one month (troponin-negative) of DAPT. We evaluated clinical outcomes in patients with and without HBR according to the Academic Research Consortium for High Bleeding Risk criteria.
Results:
From a total of 1488 patients included in this subanalysis, 406 patients (27.3 %) were identified as being at HBR. Among HBR patients, target-lesion failure (TLF) was similar after one year yet was higher after three years (13.3 % vs. 9.1 %; p = 0.013), compared to non-HBR patients. There was no difference in Bleeding Academic Research Consortium (BARC) 3 to 5 bleeding, however BARC 2 to 5 bleeding was higher after three years with 4.9 % vs. 3.0 % (p = 0.037). There were no differences between troponin-positive (12-months DAPT) and -negative (1-month DAPT) HBR patients with respect to ischemic and bleeding outcomes.
Conclusions:
In this all-comers population of PCI patients, a higher TLF rate among HBR patients at long-term follow-up was found, underlining the complexities involving treatment of HBR patients. We did not observe statistically significant differences in BARC 3 to 5 bleeding between HBR and non-HBR patients regardless of DAPT duration.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov, unique identifier: NCT02328898.
