Impact of in-hospital bleeding according to the Bleeding Academic Research Consortium classification on the long-term adverse outcomes in patients undergoing percutaneous coronary intervention.

Abstract

OBJECTIVES:

The aim of this study was to assess the impact of bleeding after percutaneous coronary intervention (PCI) with drug-eluting stents on long-term clinical events according to the newly proposed Bleeding Academic Research Consortium (BARC) classification.

BACKGROUND:

Current evidence about the impact of the BARC classification is limited.

METHODS:

Out of a total of 6,166 patients who underwent PCI in a prospective IRIS-DES registry, the impact of in-hospital bleeding defined as the BARC classification on major adverse cardiovascular events (MACE) comprising death, myocardial infarction (MI), or stroke was analyzed.

RESULTS:

In-hospital bleeding occurred in 235 patients (3.8%) according to BARC classification. During the 2-year follow-up, MACE occurred in 599 patients (9.7%). The 2-year incidence of MACE was significantly higher in patients with bleeding (16.7% vs. 8.3%; adjusted hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.2-2.3; P = 0.002) than in those without bleeding. We observed a higher risk of MI (12.4% vs. 6.4%; adjusted HR, 1.7; 95% CI, 1.2-2.6, P = 0.005), stroke (3.0% vs. 0.6%; adjusted HR, 2.9; 95% CI, 1.4-6.2, P = 0.005) in patients with bleeding. Death (3.8% vs. 1.6%; adjusted HR, 1.6; 95% CI, 0.9-3.0, P = 0.120) and target vessel revascularization (4.3% vs. 1.9%; adjusted HR, 1.6; 95% CI, 0.9-2.9, P = 0.108) were statistically insignificant. Incidence, adjusted HR and P-value were similar between BARC and TIMI classification.

CONCLUSIONS:

In-hospital bleeding events according to the newly proposed BARC definition were significantly associated with an increased risk of adverse long-term events in patients undergoing PCI with drug-eluting stents. © 2014 Wiley Periodicals, Inc.

• Authors: Yong-Hoon Yoon, Young-Hak Kim, Seon-Ok Kim, Jong-Young Lee, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 85 Issue 1 Pg. 63-71 (Jan 01 2015) ISSN: 1522-726X [Electronic] United States
• PMID: 24282105 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Validation Study)
• Copyright: © 2013 Wiley Periodicals, Inc.

Topics

• Aged
• Consensus
• Drug-Eluting Stents
• Female
• Hemorrhage (classification, diagnosis, etiology, mortality)
• Hospital Mortality
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (etiology, mortality)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Predictive Value of Tests
• Proportional Hazards Models
• Registries
• Reproducibility of Results
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stroke (etiology, mortality)
• Terminology as Topic
• Time Factors
• Treatment Outcome