Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/32864
Title: | Impact of Bleeding and Myocardial Infarction on Mortality in All-Comer Patients Undergoing Percutaneous Coronary Intervention | Authors: | Hara, Hironori Takahashi, Kuniaki Kogame, Norihiro Tomaniak, Mariusz Kerkmeijer, Laura S. M. Ono, Masafumi Kawashima, Hideyuki Wang, Rutao Gao, Chao Wykrzykowska, Joanna J. de Winter, Robbert J. Neumann, Franz-Josef Plante, Sylvain Lemos Neto, Pedro Alves Garg, Scot Juni, Peter VRANCKX, Pascal Windecker, Stephan Valgimigli, Marco Hamm, Christian Steg, Philippe Gabriel Onuma, Yoshinobu Serruys, Patrick W. |
Issue Date: | 2020 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | Circulation-Cardiovascular Interventions, 13 (9) (Art N° e009177) | Abstract: | Background: Bleeding and myocardial infarction (MI) after percutaneous coronary intervention are independent risk factors for mortality. This study aimed to investigate the association of all-cause mortality after percutaneous coronary intervention with site-reported bleeding and MI, when considered as individual, repeated, or combined events. Methods: We used the data from the GLOBAL LEADERS trial (GLOBAL LEADERS: A Clinical Study Comparing Two Forms of Anti-Platelet Therapy After Stent Implantation), an all-comers trial of 15 968 patients undergoing percutaneous coronary intervention. Bleeding was defined as Bleeding Academic Research Consortium (BARC) 2, 3, or 5, whereas MI included periprocedural and spontaneous MIs according to the Third Universal Definition. Results: At 2-year follow-up, 1061 and 498 patients (6.64% and 3.12%) experienced bleeding and MI, respectively. Patients with a bleeding event had a 10.8% mortality (hazard ratio [HR], 5.97 [95% CI, 4.76-7.49];P<0.001), and the mortality of patients with an MI was 10.4% (HR, 5.06 [95% CI, 3.72-6.90];P<0.001), whereas the overall mortality was 2.99%. Albeit reduced over time, MI and even minor BARC 2 bleeding significantly influenced mortality beyond 1 year after adverse events (HR of MI, 2.32 [95% CI, 1.18-4.55];P=0.014, and HR of BARC 2 bleeding, 1.79 [95% CI, 1.02-3.15];P=0.044). The mortality rates in patients with repetitive bleeding, repetitive MI, and both bleeding and MI were 16.1%, 19.2%, and 19.0%, and their HRs for 2-year mortality were 8.58 (95% CI, 5.63-13.09;P<0.001), 5.57 (95% CI, 2.53-12.25;P<0.001), and 6.60 (95% CI, 3.44-12.65;P<0.001), respectively. De-escalation of antiplatelet therapy at the time of BARC 3 bleeding was associated with a lower subsequent bleeding or MI rate, compared with continuation of antiplatelet therapy (HR, 0.32 [95% CI, 0.11-0.92];P=0.034). Conclusions: The fatal impact of bleeding and MI persisted beyond one year. Additional bleeding or MIs resulted in a poorer prognosis. De-escalation of antiplatelet therapy at the time of BARC 3 bleeding could have a major safety merit. These results emphasize the importance of considering the net clinical benefit including ischemic and bleeding events. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01813435. | Notes: | Serruys, PW (corresponding author), Natl Univ Ireland, Galway NUIG, Dept Cardiol, Univ Rd, Galway H91 TK33, Ireland. patrick.w.j.c.serruys@gmail.com |
Other: | Serruys, PW (corresponding author), Natl Univ Ireland, Galway NUIG, Dept Cardiol, Univ Rd, Galway H91 TK33, Ireland. patrick.w.j.c.serruys@gmail.com | Keywords: | bleeding;myocardial infarction | Document URI: | http://hdl.handle.net/1942/32864 | ISSN: | 1941-7640 | e-ISSN: | 1941-7632 | DOI: | 10.1161/CIRCINTERVENTIONS.120.009177 | ISI #: | WOS:000573509600003 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
CIRCINTERVENTIONS.120.009177.pdf | Published version | 1.37 MB | Adobe PDF | View/Open |
WEB OF SCIENCETM
Citations
15
checked on Sep 27, 2024
Page view(s)
32
checked on Jun 20, 2022
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.