Thrombosis and Major Bleeding Risk After Primary PCI Among Patients With Multivessel Coronary Artery Disease.

Xiaoxiao Zhao,Yi Chen,Jiannan Li,Zhaoxue Sheng,Chen Liu,Jinying Zhou,Peng Zhou,Runzhen Chen,Ying Wang,Hanjun Zhao,Hongbing Yan,Li Song

doi:10.3389/fcvm.2021.729432

Abstract

Background and AimThis study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multivessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI).Methods and ResultsThrombosis events (TEs) were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) three or five bleeding. The derivation and validation cohorts comprised 2,976 patients who underwent primary PCI between January 2010 and June 2017. At a median follow-up of 3.07 years (1,122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, stent thrombosis, non-use of IABP during primary PCI, type A/B according to the American College of Cardiology classification of the coronary lesion, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.82 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n = 755) was associated with higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death compared to low risk (n = 1,275) (p = 0.0022, 0.019, and 0.012, respectively). High bleeding risk (n = 1,675) was associated with higher incidence of bleeding, MACEs, and cardiac death compared to low risk (n = 355) (p < 0.0001).ConclusionSimple risk scores can be useful in predicting risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

Highlights

The risk of thrombotic events (TEs), such as myocardial infarction (MI) and stent thrombosis (ST), is lower in patients with the acute coronary syndrome who receive dual antiplatelet therapy (DAPT) with aspirin or who have undergone primary percutaneous coronary intervention (PCI) [1]
Patients [1] who refused participation, [2] who were lost to follow-up when contacted, and [3] who did not have coronary angiography parameters or multivessel coronary artery lesions were, excluded from the analysis
The strongest contributors to major bleeding (MB) were percutaneous transluminal coronary angioplasty, non-use of intra-aortic balloon pump (IABP) during primary PCI, target lesion of the left main coronary artery, triple therapy at discharge, lesion restenosis, and type A/B according to the American College of Cardiology classification of coronary lesions, without stent thrombosis and coronary artery bifurcation lesions

Summary

Introduction

The risk of thrombotic events (TEs), such as myocardial infarction (MI) and stent thrombosis (ST), is lower in patients with the acute coronary syndrome who receive dual antiplatelet therapy (DAPT) with aspirin or who have undergone primary percutaneous coronary intervention (PCI) [1]. Avoiding bleeding events is becoming increasingly important These results suggest that clinical decision-making concerning the optimal duration of DAPT for individual patients following PCI must be predicated on balancing the longterm risks of intensive antithrombotic therapy and avoiding major bleeding (MB) [4, 5]. In this context, it is essential to develop stratification tools for distinguishing high-risk ischemic patients from high-risk bleeding patients. This study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multivessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI)

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Discussion

Conclusion