Yohei Numasawa1, Shun Kohsaka2, Ikuko Ueda2, Hiroaki Miyata3, Mitsuaki Sawano2, Akio Kawamura4, Shigetaka Noma5, Masahiro Suzuki6, Susumu Nakagawa7, Yukihiko Momiyama8, Keiichi Fukuda2. 1. Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan. Electronic address: numasawa@cpnet.med.keio.ac.jp. 2. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 3. The University of Tokyo, Healthcare Quality Assessment, Tokyo, Japan. 4. Department of Cardiology, National Defense Medical College Hospital, Saitama, Japan. 5. Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan. 6. Department of Cardiology, National Hospital Organization, Saitama National Hospital, Saitama, Japan. 7. Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan. 8. Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
Abstract
BACKGROUND: Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. METHODS: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). RESULTS: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. CONCLUSIONS: The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.
BACKGROUND:Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. METHODS: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). RESULTS: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. CONCLUSIONS: The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.
Authors: Philip Urban; Roxana Mehran; Roisin Colleran; Dominick J Angiolillo; Robert A Byrne; Davide Capodanno; Thomas Cuisset; Donald Cutlip; Pedro Eerdmans; John Eikelboom; Andrew Farb; C Michael Gibson; John Gregson; Michael Haude; Stefan K James; Hyo-Soo Kim; Takeshi Kimura; Akihide Konishi; John Laschinger; Martin B Leon; P F Adrian Magee; Yoshiaki Mitsutake; Darren Mylotte; Stuart Pocock; Matthew J Price; Sunil V Rao; Ernest Spitzer; Norman Stockbridge; Marco Valgimigli; Olivier Varenne; Ute Windhoevel; Robert W Yeh; Mitchell W Krucoff; Marie-Claude Morice Journal: Eur Heart J Date: 2019-08-14 Impact factor: 29.983
Authors: Philip Urban; Roxana Mehran; Roisin Colleran; Dominick J Angiolillo; Robert A Byrne; Davide Capodanno; Thomas Cuisset; Donald Cutlip; Pedro Eerdmans; John Eikelboom; Andrew Farb; C Michael Gibson; John Gregson; Michael Haude; Stefan K James; Hyo-Soo Kim; Takeshi Kimura; Akihide Konishi; John Laschinger; Martin B Leon; P F Adrian Magee; Yoshiaki Mitsutake; Darren Mylotte; Stuart Pocock; Matthew J Price; Sunil V Rao; Ernest Spitzer; Norman Stockbridge; Marco Valgimigli; Olivier Varenne; Ute Windhoevel; Robert W Yeh; Mitchell W Krucoff; Marie-Claude Morice Journal: Circulation Date: 2019-05-22 Impact factor: 29.690
Authors: Shashank Murali; Sara Vogrin; Samer Noaman; Diem T Dinh; Angela L Brennan; Jeffrey Lefkovits; Christopher M Reid; Nicholas Cox; William Chan Journal: J Clin Med Date: 2020-05-11 Impact factor: 4.241
Authors: Thomas A Meijers; Adel Aminian; Koen Teeuwen; Marleen van Wely; Thomas Schmitz; Maurits T Dirksen; Rene J van der Schaaf; Juan F Iglesias; Pierfrancesco Agostoni; Joseph Dens; Paul Knaapen; Sudhir Rathore; Jan Paul Ottervanger; Jan-Henk E Dambrink; Vincent Roolvink; A T Marcel Gosselink; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: BMJ Open Date: 2020-07-20 Impact factor: 2.692
Authors: Christian Dworeck; Björn Redfors; Sebastian Völz; Inger Haraldsson; Oskar Angerås; Truls Råmunddal; Dan Ioanes; Anna Myredal; Jacob Odenstedt; Geir Hirlekar; Sasha Koul; Ole Fröbert; Rickard Linder; Dimitrios Venetsanos; Robin Hofmann; Anders Ulvenstam; Petur Petursson; Giovanna Sarno; Stefan James; David Erlinge; Elmir Omerovic Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-06