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Tokuda T, Yoshioka N, Koyama A, Yamada T, Shimamura K, Nishikawa R. Chronic Limb-Threatening Ischemia is a Residual Bleeding Risk Factor among Patients with Lower Extremity Artery Disease. J Atheroscler Thromb 2024; 31:100-108. [PMID: 37532569 PMCID: PMC10776334 DOI: 10.5551/jat.64242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
AIM Lower-extremity artery disease (LEAD) is a high-risk factor for bleeding. However, the specific risk factors for bleeding in patients with LEAD remain unclear. We aimed to identify risk factors for bleeding in patients with LEAD after endovascular treatment (EVT). METHODS This multicenter, retrospective, observational study included 732 consecutive patients with LEAD who underwent EVT between January 2018 and December 2019. Patient characteristics, laboratory data, target lesions, and medications were compared between patients with and without chronic limb-threatening ischemia (CLTI). Predictive bleeding risk factors were explored using Cox regression analysis with differential models. RESULTS In model 1, a body mass index (BMI) <18.5 kg/m2, prior heart failure, high bleeding risk, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were predictive bleeding risk factors (hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.13-3.52; p<0.01; HR 2.15; 95% CI 1.28-3.55; p<0.01; HR 3.40; 95% CI 1.28-3.55; p<0.01; HR 2.05; 95% CI 1.33-5.84; p<0.01; respectively). In model 2, a BMI <18.5 kg/m2, prior heart failure, anemia (<11 g/dL), low platelet count (<10*104/µL), chronic kidney disease, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were independent risk factors for bleeding (model 2: HR 2.05; 95% CI 1.12-3.56; p=0.02; HR 2.35; 95% CI 1.39-3.90; p<0.01; HR 2.71; 95% CI 1.64-4.50; p<0.01; HR 2.66; 95% CI 1.00-5.89; p=0.05; HR 2.47; 95% CI 1.25-5.45; p<0.01; HR 2.79; 95% CI 1.24-5.63; p=0.01; respectively) Conclusions: CLTI is a residual and predictive risk factor for bleeding in patients with LEAD. We have to pay attention to the bleeding events of patients with CLTI after EVT during follow-up.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Aichi, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Jung J, Seo Y, Her SH, Lee JH, Lee K, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Prognostic Impact of Atrial Fibrillation in Patients with Heavily Calcified Coronary Artery Disease Receiving Rotational Atherectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1808. [PMID: 37893526 PMCID: PMC10608542 DOI: 10.3390/medicina59101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Although both rotational atherectomy (RA) and atrial fibrillation (AF) have a high thrombotic risk, there have been no previous studies on the prognostic impact of AF in patients who undergo percutaneous coronary intervention (PCI) using RA. Thus, the aim of the present study was to determine the prognostic impact of AF in patients undergoing PCI using RA. Materials and Methods: A total of 540 patients who received PCI using RA were enrolled between January 2010 and October 2019. Patients were divided into AF and sinus rhythm groups according to the presence of AF. The primary endpoint was net adverse clinical events (NACEs) defined as a composite outcome of all-cause death, myocardial infarction, target vessel revascularization, cerebrovascular accident, or total bleeding. Results: Although in-hospital adverse events showed no difference between those with AF and those without AF (in-hospital events, 54 (11.0%) vs. 6 (12.2%), p = 0.791), AF was strongly associated with an increased risk of NACE at 3 years (NACE: hazard ratio, 1.880; 95% confidence interval, 1.096-3.227; p = 0.022). Conclusions: AF in patients who underwent PCI using RA was strongly associated with poor clinical outcomes. Thus, more attention should be paid to thrombotic and bleeding risks.
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Affiliation(s)
- Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Yeonjoo Seo
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea;
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Chonbuk National University Hospital, Jeonju 54907, Republic of Korea;
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Republic of Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea;
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