Trade-off of major bleeding versus myocardial infarction on mortality after percutaneous coronary intervention

Abstract

BackgroundThe choice of antithrombotic therapy after percutaneous coronary intervention (PCI) is heavily dependent on the relative trade-off between major bleeding (MB) and myocardial infarction (MI). However, the mortality trade-off was mostly described in Western populations and remained unknown in East Asians.MethodThis was a retrospective cohort study from 14 hospitals under the Hospital Authority of Hong Kong between 2004 and 2017. Participants were patients undergoing first-time PCI and survived for the first year. Patients were stratified by the presence of MB and MI during the first year. The primary endpoint was all-cause mortality between 1 and 5 years after PCI. The secondary endpoint was cardiovascular mortality.ResultsA total of 32 180 patients were analysed. After adjustment for baseline characteristics and using patients with neither events as reference, the risks of all-cause mortality were increased in patients with MI only (HR, 1.63; 95% CI 1.45 to 1.84; p<0.001), further increased in those with MB only (HR, 2.11, 95% CI 1.86 to 2.39; p<0.001) and highest in those with both (HR, 2.92; 95% CI 2.39 to 3.56; p<0.001). In both Cox regression and propensity score analyses, MB had a stronger impact on all-cause mortality than MI, but similar impact on cardiovascular mortality.ConclusionsBoth MB and MI within the first year after PCI were associated with increase in all-cause and cardiovascular mortality in Chinese patients, but the impact was stronger with MB.

Reduced-dose without the post-procedure infusion of bivalirudin in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention

“…The CRUSADE score of the bivalirudin group in the BRIGHT study was (19.6 ± 11.9), that of the reduced-dose group was (26.79 ± 11.32), and that of the recommended-dose group was (27.26 ± 11.57), both of which in our study were higher than those in the BRIGHT study (all P < 0.001). Although all bleeding events increased, the incidence of major bleeding decreased.Studies (27)(28)(29) have shown that reducing the incidence of major bleeding in patients undergoing PCI is associated with postoperative adverse events. In our study, the proportion of ACT values ≥ 350 s in the recommended-dose group was signi cantly higher than that in the reduced-dose group (56.7% vs. 48.2%, P = 0.001), and there was a greater tendency for major bleeding (0.5% vs. 0.3%, P = 0.687).…”

The Prognostic Impact of In-Hospital Major Bleeding and Recurrence of Myocardial Infarction during Acute Phase after Percutaneous Coronary Intervention for Acute Myocardial Infarction

“…Many studies have reported a strong association between major bleeding and mortality 4,7,12,14,15) . Major bleeding such as intracranial hemorrhage or severe blood loss as can occur in gastrointestinal hemorrhage also may directly result in mortality, although such bleeding events would not explain the prolonged mortality risk observed after a major bleeding event.…”