Prognostic impact of peripheral artery disease in patients with and without high bleeding risk undergoing percutaneous coronary intervention

Abstract

BackgroundPeripheral artery disease (PAD) is associated with worse outcomes after percutaneous coronary intervention (PCI). The aim of this study was to assess the prognostic impact of PAD according to high bleeding risk (HBR) status.MethodsConsecutive patients undergoing PCI with drug‐eluting stent implantation at a tertiary‐care center (Mount Sinai Hospital) between 2012 and 2019 were stratified according to HBR and PAD status. The primary outcome was major adverse cardiac events (MACE), a composite of all‐cause death, myocardial infarction (MI), and stroke 1 year after PCI. Secondary outcomes included major bleeding.ResultsOut of 16,750 patients, 43% were HBR and 57% were no‐HBR. Within the two groups, PAD patients were 14% and 6%, respectively, and were more likely to have comorbidities and to undergo complex PCI than no‐PAD patients. Within the HBR group, PAD was associated with an increased risk of MACE (11.4% vs. 7.3%, hazard ratio [HR]: 1.59, 95% confidence interval [CI]: 1.27–1.99, p < 0.001) and a numerical nonsignificant increase of major bleeding (8.5% vs. 6.9%, HR: 1.25, 95% CI: 0.98–1.59, p = 0.066) as compared with no‐PAD. Among no‐HBR patients, rates of MACE and major bleeding were numerically but not significantly higher in the PAD group. After multivariable adjustment, PAD was no longer a predictor of adverse outcomes, irrespective of HBR status.ConclusionsAt 1‐year after PCI, PAD was associated with increased 1‐year risks of MACE in HBR patients. After adjustment for cardiovascular risk factors and comorbidities, the effect of PAD on adverse events was largely attenuated.

ABC as in Arteriopathy, Bleeding, and Coronary disease: Disentangling the prognostic conundrum of patients undergoing percutaneous coronary intervention with concomitant peripheral artery disease

“…1,2 In this issue of the Journal, Spirito et al timely focus their analytical eye on the independent contribution to clinical outcomes of both PAD and high bleeding risk (HBR). 3 The main findings of their work are that, apparently, both PAD and HBR have an adverse prognostic impact. For instance, patients with PAD at average bleeding risk face a 5.0% death rate at 1 year of follow-up, in comparison to 2.4% in those without PAD.…”