Sorin J Brener1, Ajay J Kirtane2, Thomas D Stuckey3, Bernhard Witzenbichler4, Michael J Rinaldi5, Franz-Josef Neumann6, D Christopher Metzger7, Timothy D Henry8, David A Cox9, Peter L Duffy10, Ernest L Mazzaferri11, Roxana Mehran12, Rupa Parvataneni13, Bruce R Brodie3, Gregg W Stone2. 1. New York Methodist Hospital, Brooklyn, New York. Electronic address: sjb9005@nyp.org. 2. Cardiovascular Research Foundation, New York, New York; New York Presbyterian-Columbia University Medical Center, New York, New York. 3. LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina. 4. Helios Amper-Klinikum, Dachau, Germany. 5. Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, North Carolina. 6. Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany. 7. Wellmont CVA Heart Institute, Kingsport, Tennessee. 8. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California. 9. Lehigh Valley Health Network, Allentown, Pennsylvania. 10. Reid Heart Center, First Health of the Carolinas, Pinehurst, North Carolina. 11. The Ohio State University Wexner Medical Center, Columbus, Ohio. 12. Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York. 13. Cardiovascular Research Foundation, New York, New York.
Abstract
OBJECTIVES: The aim of this study was to understand the impact of the timing of ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) with drug-eluting stents on subsequent mortality. BACKGROUND: These events have been strongly associated with subsequent death. METHODS: In the multicenter, prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents) study, patients at 11 clinical sites with successful PCI with drug-eluting stents underwent assessment of platelet function and were followed for 2 years. Events occurring after PCI-definite or probable stent thrombosis (ST), myocardial infarction (MI) not related to ST, and clinically relevant bleeding (CB)-were classified as early (≤30 days), late (31 to 365 days), or very late (>365 days). Mortality within 30 days of each event was estimated by Kaplan-Meier methodology. Cox regression multivariate modeling was used to analyze the relationship between each event (as a time-updated variable) and mortality over the entire study period. RESULTS: Among 8,582 patients, 1,060 (12.4%) had events-691 (8.1%) had CB, 294 (3.4%) had MI, and 75 (0.9%) had ST-and 7,522 (87.6%) had no events. The highest risk was associated with early ST (38.5% mortality at 30 days after the event), whereas very late MI (7.5%) and late CB (7.3%) were less dangerous. By multivariate analysis, each event was independently predictive of death, with hazard ratios of 2.4, 1.8, and 11.4, respectively (p < 0.0001). CONCLUSIONS: Approximately 1 in 8 patients successfully undergoing PCI with drug-eluting stents had CB, MI, or ST during the ensuing 2 years. These events are associated with an increased hazard of mortality, particularly within the first 30 days following the event, warranting efforts to prevent their occurrence.
OBJECTIVES: The aim of this study was to understand the impact of the timing of ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) with drug-eluting stents on subsequent mortality. BACKGROUND: These events have been strongly associated with subsequent death. METHODS: In the multicenter, prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents) study, patients at 11 clinical sites with successful PCI with drug-eluting stents underwent assessment of platelet function and were followed for 2 years. Events occurring after PCI-definite or probable stent thrombosis (ST), myocardial infarction (MI) not related to ST, and clinically relevant bleeding (CB)-were classified as early (≤30 days), late (31 to 365 days), or very late (>365 days). Mortality within 30 days of each event was estimated by Kaplan-Meier methodology. Cox regression multivariate modeling was used to analyze the relationship between each event (as a time-updated variable) and mortality over the entire study period. RESULTS: Among 8,582 patients, 1,060 (12.4%) had events-691 (8.1%) had CB, 294 (3.4%) had MI, and 75 (0.9%) had ST-and 7,522 (87.6%) had no events. The highest risk was associated with early ST (38.5% mortality at 30 days after the event), whereas very late MI (7.5%) and late CB (7.3%) were less dangerous. By multivariate analysis, each event was independently predictive of death, with hazard ratios of 2.4, 1.8, and 11.4, respectively (p < 0.0001). CONCLUSIONS: Approximately 1 in 8 patients successfully undergoing PCI with drug-eluting stents had CB, MI, or ST during the ensuing 2 years. These events are associated with an increased hazard of mortality, particularly within the first 30 days following the event, warranting efforts to prevent their occurrence.
Authors: Angela Lowenstern; Steven J Lippmann; J Matthew Brennan; Tracy Y Wang; Lesley H Curtis; Ted Feldman; Donald D Glower; Bradley G Hammill; Sreekanth Vemulapalli Journal: Circ Cardiovasc Interv Date: 2019-05 Impact factor: 6.546
Authors: Oskar Angerås; Inger Haraldsson; Björn Redfors; Ole Fröbert; Petur Petursson; Per Albertsson; Dan Ioanes; Jacob Odenstedt; Hans Olsson; Nils Witt; Andreas Rück; Jonas Millgård; Johan Nilsson; Jonas Persson; Måns Söderbom; Hans Wedel; David Erlinge; Stefan James; Truls Råmunddal; Elmir Omerovic Journal: J Am Heart Assoc Date: 2018-01-09 Impact factor: 5.501
Authors: J M Ten Berg; B Zwart; A W J van 't Hof; A Liem; J Waltenberger; R J de Winter; J W Jukema Journal: Neth Heart J Date: 2017-12 Impact factor: 2.380