Impact of Nutritional and Inflammation Status on Long-Term Bleeding in Patients Undergoing Percutaneous Coronary Intervention with an Oral Anticoagulant

Abstract

Aim: Patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet therapy (APT) are exposed to a serious risk of bleeding. The aim of this study was to clarify the relationship among nutritional and inflammation status and long-term bleeding in patients requiring both OACs and APT after PCI. Methods: We performed PCI in 3,718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OACs and APT. Patients were followed for up to 3 years for bleeding events, defined as the Bleeding Academic Research Consortium (BARC) class ≥3 bleeding. We retrospectively evaluated the ability of the Geriatric Nutritiosk Index (GNRI) and high-sensitivity C-reactive protein (hs-CRP) to detect bleeding events. Results: During a median follow-up of 1,080 days, bleeding events were observed in 53 (17.5%) patients. Bleeding events were associated with a low GNRI (≤98) (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.84–5.45; p <0.0001) and hs-CRP level ≥2.5 mg/L (HR, 2.75; 95% CI, 1.61–4.78; p =0.0003). A low GNRI+high hs-CRP showed a 5.12-fold increase in the incidence of BARC class ≥3 bleeding (95% CI, 2.68–9.91; p <0.0001) compared with a normal GNRI+low hs-CRP. The addition of the GNRI and hs-CRP to the PRECISEDAPT score improved C-statistics from 0.67 to 0.71 and enhanced the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.36, p <0.0001; IDI, 0.066, p <0.0001). Conclusions: The GNRI and hs-CRP were novel predictors of the long-term bleeding risk in patients requiring both OACs and APT after PCI.

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

“…As an indicator of inflammation, hs-CRP has been thought to be closely related to the risk of death and ischemic events in patients with CHD ( 18 – 20 ). The results of this study showed that the higher hs-CRP was, the patient presented more HTPR.…”

“…Inflammatory biomarkers have also become the therapeutic target for CHD in era of “poststatins,” as recent CANTOS ( 12 ) and LoDoCo2 ( 13 ) trails established that anti-inflammation improves the prognosis of CHD. Previous studies have shown that elevated leukocyte count ( 14 – 17 ) and hs-CRP ( 18 – 20 ) were associated with bleeding and thrombotic adverse events in PCI patients, however, the mechanism of the increased risk is unknown.…”

Malnutrition and Clopidogrel Non-Use Worsen Prognosis of Critical Limb Ischemia Patients After Revascularization

“…Yoshida et al found that low GNRI and hs-CRP were predictors of bleeding risk in patients requiring antiplatelet therapy after PCI. 27 Katsanos et al showed that clopidogrel monotherapy was associated with the most favorable harm-benefit profile without being associated with an increased risk of severe bleeding in PAD patients. 28 Furthermore, a recent study also reported that clopidogrel therapy extended beyond 12 months was associated with decreased risk of all-cause death or non-fatal MI in DM patients after second-generation drug-eluting stent implantation in PCI.…”

A New Preprocedural Score to Predict Bleeding Complications of Endovascular Interventions for Peripheral Artery Disease

“…Specifically, in a retrospective study that included 3718 consecutive patients who underwent percutaneous coronary interventions, a low geriatric nutritional risk index and high-sensitivity C-reactive protein were correlated with a 5-fold increase in the incidence of Bleeding Academic Research Consortium class ≥3 bleeding. 35 However, these specific predictors were not evaluated in the current protocol because these data were published after the study was initiated. Moreover, the purpose of this study was to develop a simple and not particularly demanding bleeding score that could be rapidly utilized in preprocedural safety assessment.…”