Incidence, Prediction, and Outcomes of Major Bleeding After Percutaneous Coronary Intervention in Chinese Patients.

Abstract

The patterns of late major bleeding (MB) after percutaneous coronary intervention (PCI) remain unknown in Chinese patients. This study sought to determine the incidence, prediction, and long-term outcomes of late MB in Chinese patients. This was a retrospective cohort study from 14 hospitals in Hong Kong. Participants were patients undergoing first-time PCI without MB within 30days or death within 1 year. Patients were stratified by the presence of late MB, defined as MB between 30 and 365days. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac events (MACE). A total of 32,057 patients were analyzed. After adjustment for baseline characteristics, periprocedural characteristics, and medications on discharge, the risks of all-cause mortality at 5 years were significantly higher with late MB (HR: 2.15; 95%CI: 1.92-2.41; P< 0.001). Late MB was also associated with a higher risk of MACE (HR: 1.57; 95%CI: 1.03-1.50; P< 0.001), myocardial infarction (HR: 1.25; 95%CI: 1.04-1.52; P = 0.02), and stroke (HR: 1.38; 95%CI: 1.09-1.73; P = 0.006). The CARDIAC (anti-Coagulation therapy, Age, Renal insufficiency, Drop In hemoglobin, baseline Anemia in Chinese patients) score had a good discriminating power for prediction of MB within 365days (area under the receiver-operating characteristic curve: 0.76). Late MB was independently associated with a higher risk of mortality, MACE, myocardial infarction, and stroke in patients undergoing PCI. The CARDIAC score is a simple model that can predict MB after PCI. Prevention of MB represents an important strategy to optimize cardiovascular outcomes for patients undergoing PCI.