Usman Baber1, George Dangas1, Jaya Chandrasekhar1, Samantha Sartori1, Philippe Gabriel Steg2, David J Cohen3, Gennaro Giustino1, Cono Ariti4, Bernhard Witzenbichler5, Timothy D Henry6, Annapoorna S Kini1, Mitchell W Krucoff7, C Michael Gibson8, Alaide Chieffo9, David J Moliterno10, Giora Weisz11, Antonio Colombo9, Stuart Pocock4, Roxana Mehran12. 1. Icahn School of Medicine at Mount Sinai, New York, New York. 2. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. 3. St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri. 4. London School of Hygiene and Tropical Medicine, London, United Kingdom. 5. Helios Amper-Klinikum, Dachau, Germany. 6. Cedars-Sinai Medical Center, Los Angeles, California. 7. Duke University School of Medicine, Durham, North Carolina. 8. Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 9. Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy. 10. University of Kentucky, Lexington, Kentucky. 11. Shaare Zedek Medical Center, Jerusalem, Israel. 12. Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Abstract
OBJECTIVES: The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention (PCI). BACKGROUND: The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized. METHODS: A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 patients undergoing PCI with stent implantation. CTE included definite or probable stent thrombosis or myocardial infarction. AB was defined as Bleeding Academic Research Consortium type 2 or 3. Associations between CTE and AB, both of which were modeled as time-dependent covariates, and 2-year mortality risk were examined using extended Cox regression. RESULTS: Over 2 years, the cumulative incidence of CTE, AB, and all-cause mortality was 5.9% (n = 289), 8.1% (n = 391), and 4.7% (n = 227), respectively. Adjusted hazard ratios for mortality associated with CTE and AB were 3.3 (95% confidence interval: 2.2 to 4.9) and 3.5 (95% confidence interval: 2.3 to 5.4), respectively. Temporal gradients in risk after either event were highest in the first 30 days and declined rapidly thereafter. Thrombotic events occurring while patients were on versus off dual-antiplatelet therapy were associated with a higher mortality risk, whereas risk related to AB was not influenced by dual-antiplatelet therapy status at the time of bleeding. CONCLUSIONS: Intracoronary thrombosis and AB are associated with mortality risks of comparable magnitude over a 2-year period after PCI, findings that might inform risk/benefit calculations for extension versus discontinuation of dual-antiplatelet therapy.
OBJECTIVES: The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention (PCI). BACKGROUND: The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized. METHODS: A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 patients undergoing PCI with stent implantation. CTE included definite or probable stent thrombosis or myocardial infarction. AB was defined as Bleeding Academic Research Consortium type 2 or 3. Associations between CTE and AB, both of which were modeled as time-dependent covariates, and 2-year mortality risk were examined using extended Cox regression. RESULTS: Over 2 years, the cumulative incidence of CTE, AB, and all-cause mortality was 5.9% (n = 289), 8.1% (n = 391), and 4.7% (n = 227), respectively. Adjusted hazard ratios for mortality associated with CTE and AB were 3.3 (95% confidence interval: 2.2 to 4.9) and 3.5 (95% confidence interval: 2.3 to 5.4), respectively. Temporal gradients in risk after either event were highest in the first 30 days and declined rapidly thereafter. Thrombotic events occurring while patients were on versus off dual-antiplatelet therapy were associated with a higher mortality risk, whereas risk related to AB was not influenced by dual-antiplatelet therapy status at the time of bleeding. CONCLUSIONS: Intracoronary thrombosis and AB are associated with mortality risks of comparable magnitude over a 2-year period after PCI, findings that might inform risk/benefit calculations for extension versus discontinuation of dual-antiplatelet therapy.
Authors: Henri Kesti; Henna Mäkinen; Kalle Mattila; Samuli Jaakkola; Mikko Lintu; Pekka Porela Journal: J Clin Med Date: 2022-02-28 Impact factor: 4.241