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Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention

Open access
Généreux, Philippe, Giustino, Gennaro, Witzenbichler, Bernhard, Weisz, Giora, Stuckey, Thomas D., Rinaldi, Michael J., Neumann, Franz-Josef, Metzger, D. Christopher, Henry, Timothy D., Cox, David A., Duffy, Peter L., Mazzaferri, Ernest, Yadav, Mayank, Francese, Dominic P., Palmerini, Tullio, Kirtane, Ajay J., Litherland, Claire, Mehran, Roxana, Stone, Gregg W.·2015·Journal of the American College of Cardiology

Abstract

BACKGROUND The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. OBJECTIVES This study sought to characterize the determinants and consequences of PDB after PCI. METHODS The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. RESULTS Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009). CONCLUSIONS After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).

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Metadata

Authors
Généreux, P., Giustino, G., Witzenbichler, B., Weisz, G., Stuckey, T. D., Rinaldi, M. J., Neumann, F.-J., Metzger, D. C., Henry, T. D., Cox, D. A., Duffy, P. L., Mazzaferri, E., Yadav, M., Francese, D. P., Palmerini, T., Kirtane, A. J., Litherland, C., Mehran, R., & Stone, G. W.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-09
Volume
66
Issue
9
Pages
1036-1045
ISSN
0735-1097 (ISSN-L)
OpenAlex
W1808601199
Cited by
454
References
26
FWCI
24.31
Type
journal article
Language
en
Open access
bronze

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Généreux, P., Giustino, G., Witzenbichler, B., Weisz, G., Stuckey, T. D., Rinaldi, M. J., Neumann, F.-J., Metzger, D. C., Henry, T. D., Cox, D. A., Duffy, P. L., Mazzaferri, E., Yadav, M., Francese, D. P., Palmerini, T., Kirtane, A. J., Litherland, C., Mehran, R., & Stone, G. W. (2015). Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2015.06.1323

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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