Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries

Abstract

Introduction. The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the firstyear of follow-up according to clinical presentation, medical and interventional strategies.Methods. BleeMACS and Renami are two multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary endpoints. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup.Results. 19,826 patients were included. Overall, in the first year after PCI the ADBR was 0.008085%, while ADIR was 0.008017% (p=0.886). In the first 2 weeks ADIR was higher than ADBR (p=0.013), especially in patients with STEMI or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the 3 rd month, while ADBR became higher, although not significantly, afterwards. Patients with incomplete revascularization had an excess in ischemic risk (p=0.003), while non-STelevation-ACS patients (NSTE-ACS) and those on ticagrelor had an excess of bleeding (p=0.012 and p=0.022 respectively). Conclusions.In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in STEMI patients and those with incomplete revascularization. In the first year ADIR was higher than ADBR in patients with incomplete revascularization, while ADBR was higher in NSTE-ACS patients and in those discharged on ticagrelor.

Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry

“…DAPT with potent P2Y12 inhibitors are the keystone of ACS treatment in the general adult population, as previous evidence demonstrated the benefit of this strategy in decreasing cardiovascular mortality, recurrent MI or coronary revascularization after ACS due to the reduction of the thrombotic risk [14]. However, such benefit comes invariably at expense of an increased risk of bleeding events [5,6].…”

Effect of thrombus aspiration on microcirculatory resistance and ventricular function in patients with high thrombus burden

“…There were insufficient data to assess the potential benefit of a strategy of selective or bailout aspiration thrombectomy (Class IIb, LOE C-LD), defined as unplanned thrombectomy performed due to unsatisfactory initial result or procedural complication, analogous to the definition of "bailout" glycoprotein IIb/IIIa use [19]. Recent studies have demonstrated the benefit of complete revascularization [20,21], nevertheless, at the time this study was conducted, we only performed culprit-only PCI. Hence, this issue was not expected to greatly influence the analysis and its result.…”

Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation

“…In addition, these regimens may substantially increase bleeding risk, especially during the early TAT period [2,8]. Recent studies have demonstrated that both average daily bleeding rates and average daily ischemic rates are highest during the first month immediately after PCI, followed by a gentle downward curve [17,18]. These high bleeding rate and ischemic rate in the first month after the PCI is estimated to be even higher in AF patients undergoing PCI.…”