Abstract 12805: Incidence and Predictors of Myocardial Infarction or Stent Thrombosis in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention

Abstract

Introduction: High-bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) are often at high risk for thrombotic complications following coronary stenting. We sought to evaluate the frequency and predictors of myocardial infarction (MI) or stent thrombosis (ST) events in HBR patients at 1 year after PCI. Methods: We included HBR patients undergoing PCI with drug-eluting stent implantation at a tertiary-care center, between 2012 and 2019. HBR status was defined as the presence of ≥1 major or ≥2 minor Academic Research Consortium-HBR criteria. Clinical and angiographic baseline characteristics were analyzed after stratifying patients by the occurrence of MI/ST. Independent predictors of MI/ST at 1-year follow-up were assessed using Cox multivariate regression analysis. Results: Among 7,806 HBR patients undergoing PCI, 245 (3.1%) experienced MI/ST within one year of the index procedure. These patients were more frequently female (42.6% vs. 35.7%, p=0.03), had a higher prevalence of insulin-dependent diabetes mellitus (62.3% vs. 40.5%, p<0.001), peripheral artery disease (18.4% vs. 13.4%, p=0.03), chronic kidney disease (57.1% vs. 52.1%, p=0.006), and a history of prior PCI (57.1% vs. 45.7%, p<0.001). Furthermore, they were more likely to undergo complex PCI (43.3% vs. 32.3%, p<0.001) and had a higher mean syntax score (20.6±12.5 vs. 14.2±10.8, p<0.001). Multivessel disease was the most prevalent and strongest predictor of MI/ST at 1-year follow-up, followed by acute coronary syndrome and diabetes mellitus ( Figure ). Conclusions: MI/ST events frequently occur in HBR patients undergoing PCI. Predictors of MI/ST must be accounted for while deciding on the optimal antithrombotic therapy strategy in these patients.