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Long-term outcomes of high bleeding risk patients undergoing percutaneous coronary intervention: a Korean nationwide
Jeehoon Kang1,2, Junpil Yun1, Kyung Woo Park1
1Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Insights
Patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) face increased long-term risks for bleeding, ischaemic events, and mortality. This highlights the need for careful management strategies in HBR populations post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Patients undergoing percutaneous coronary intervention (PCI) with high bleeding risk (HBR) experience elevated risks of both bleeding and ischaemic events.
- Understanding the long-term implications for HBR patients is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the long-term relative risk of ischaemic and bleeding events in patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A nationwide cohort study utilized the Korean National Health Insurance Review and Assessment Service database.
- Patients undergoing PCI between 2009 and 2018 were categorized into HBR and non-HBR groups based on Academic Research Consortium criteria.
- Co-primary outcomes included major bleeding events and a composite of ischaemic events (cardiac death, myocardial infarction, ischaemic stroke).
Main Results:
- Out of 325,417 patients, 66,426 (20.4%) were classified as HBR.
- HBR patients demonstrated significantly higher risks for major bleeding (23.9% vs. 8.9%) and ischaemic events (33.8% vs. 14.4%) compared to non-HBR patients.
- HBR was associated with substantially increased hazard ratios for bleeding (3.12) and ischaemic events (2.50), as well as all-cause mortality (3.73).
Conclusions:
- Patients with high bleeding risk (HBR) undergoing PCI face significantly increased long-term risks for major bleeding, ischaemic events, and all-cause mortality.
- These findings underscore the critical need for tailored management approaches for HBR patients post-PCI to mitigate adverse outcomes.
Background And Aims:
Patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) are at increased risk of not only bleeding, but also ischaemic events. This study aimed to determine the long-term relative risk of ischaemic and bleeding events in HBR patients.
Methods:
This study was a nationwide cohort study, based on the Korean National Health Insurance Review and Assessment Service database. Patients diagnosed with stable angina or acute coronary syndrome and those who underwent PCI in Korea between 2009 and 2018 were included in the analysis. According to the Academic Research Consortium HBR criteria, the total population was divided into HBR and non-HBR groups. The co-primary outcomes were major bleeding events and ischaemic (composite of cardiac death, myocardial infarction, and ischaemic stroke) events.
Results:
Among a total of 325 417 patients who underwent PCI, 66 426 patients (20.4%) had HBR. During the follow-up period, HBR patients had a higher risk for major bleeding events (23.9% vs. 8.9%, P < .001) and ischaemic events (33.8% vs. 14.4%, P < .001). However, the impact of HBR was significant for major bleeding events [hazard ratio (HR) 3.12, 95% confidence interval (CI) 3.04-3.21, P < .001] and for ischaemic events (HR 2.50, 95% CI 2.45-2.56, P < .001). The HBR group was also associated with a greater risk of all-cause mortality (HR 3.73, 95% CI 3.66-3.79, P < .001). The average annual rate of major bleeding events within the first year after PCI was 5.5% for a single major criterion, and 2.9% for a single minor criterion.
Conclusions:
Among patients undergoing PCI, those with HBR were at increased long-term risk for both bleeding and ischaemic events, with a greater risk of mortality compared to non-HBR patients.
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