Abstract | OBJECTIVES: The aim of this study was to assess the impact of early and late bleeding on subsequent mortality after drug-eluting stent (DES) implantation. BACKGROUND: Little is known about the impact of late bleeding after DES implantation. METHODS: RESULTS:
Bleeding, defined according to STEEPLE (Safety and Efficacy of Enoxaparin in PCI Patients, an International Randomized Evaluation) minor or major criteria, occurred in 6.5% of patients over 3 years. Patients with bleeding were older; were more likely to be female; had higher rates of diabetes mellitus, hypertension, and extensive coronary disease and lower ventricular function; and underwent more complex procedures than those without bleeding. The 3-year adjusted hazard ratios (HRs) for mortality were 5.81 (95% confidence interval [CI]: 3.92 to 8.60; p < 0.001) for patients with bleeding and 2.53 (95% CI: 1.62 to 3.96; p < 0.001) for patients with MI. When the timings of events were separated, the HRs for mortality were 4.89 (95% CI: 3.08 to 7.78; p < 0.001) and 7.81 (95% CI: 4.39 to 13.89; p < 0.001) for patients with bleeding within and after 30 days, respectively. By contrast, the HRs for mortality were 1.85 (95% CI: 1.09 to 3.14, p = 0.022) and 10.33 (95% CI: 4.91 to 21.75, p < 0.001) for patients with MI within and after 30 days, respectively. CONCLUSIONS:
Bleeding is closely associated with mortality during both the early and late periods after DES implantation. Therefore, in addition to carefully assessing bleeding after stenting, evidence-based treatment should be implemented to offer the best balance of benefit and harm.
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Authors | Young-Hak Kim, Jong-Young Lee, Jung-Min Ahn, Haegeun Song, Won-Jang Kim, Sung-Cheol Yun, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park |
Journal | JACC. Cardiovascular interventions
(JACC Cardiovasc Interv)
Vol. 4
Issue 4
Pg. 423-31
(Apr 2011)
ISSN: 1876-7605 [Electronic] United States |
PMID | 21511222
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Angioplasty, Balloon, Coronary
(adverse effects, instrumentation, mortality)
- Coronary Disease
(mortality, therapy)
- Drug-Eluting Stents
- Female
- Hemorrhage
(etiology, mortality)
- Hospital Mortality
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Myocardial Infarction
(etiology, mortality)
- Proportional Hazards Models
- Registries
- Republic of Korea
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
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