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Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries.

AbstractBACKGROUND:
The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies.
METHODS:
BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup.
RESULTS:
A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively).
CONCLUSIONS:
In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.
AuthorsFabrizio D'Ascenzo, Carloalberto Biolè, Sergio Raposeiras-Roubin, Federico Gaido, Emad Abu-Assi, Tim Kinnaird, Albert Ariza-Solé, Christoph Liebetrau, Sergio Manzano-Fernández, Giacomo Boccuzzi, Jose Paulo Simao Henriques, Christian Templin, Stephen B Wilton, Pierluigi Omedè, Lazar Velicki, Ioanna Xanthopoulou, Luis Correia, Enrico Cerrato, Andrea Rognoni, Ugo Fabrizio, Iván Nuñez-Gil, Andrea Montabone, Salma Taha, Toshiharu Fujii, Alessandro Durante, Xiantao Song, Sebastiano Gili, Giulia Magnani, Michele Autelli, Federica Bongiovanni, Alberto Grosso, Tetsuma Kawaji, Pedro Flores Blanco, Alberto Garay, Giorgio Quadri, Dimitrios Alexopoulos, Berenice Caneiro Queija, Zenon Huczek, Rafael Cobas Paz, José Ramón González-Juanatey, María Cespón Fernández, Shao-Ping Nie, Isabel Muñoz Pousa, Masa-Aki Kawashiri, Sara Rettegno, Diego Gallo, Umberto Morbiducci, Federico Conrotto, Alberto Dominguez-Rodriguez, Mariano Valdés, Angel Cequier, Andrés Iñiguez-Romo, Giuseppe Biondi-Zoccai, Gregg W Stone, Gaetano Maria De Ferrari
JournalAmerican heart journal (Am Heart J) Vol. 220 Pg. 108-115 (02 2020) ISSN: 1097-6744 [Electronic] United States
PMID31809991 (Publication Type: Journal Article, Multicenter Study)
CopyrightCopyright © 2019 Elsevier Inc. All rights reserved.
Chemical References
  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Prasugrel Hydrochloride
  • Ticagrelor
Topics
  • Acute Coronary Syndrome (therapy)
  • Aged
  • Clopidogrel (therapeutic use)
  • Female
  • Hemorrhage (epidemiology, etiology)
  • Humans
  • Ischemia (epidemiology, etiology)
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention (adverse effects)
  • Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
  • Postoperative Complications (epidemiology, etiology)
  • Prasugrel Hydrochloride (therapeutic use)
  • Recurrence
  • Registries
  • ST Elevation Myocardial Infarction (complications, therapy)
  • Ticagrelor (adverse effects, therapeutic use)
  • Time Factors

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