1
|
Paradies V, Maurina M, Tonino P, Hofma SH, Vos J, van Kuijk JP, Oemrawsingh RM, Mafragi AA, Spano F, Pisters R, Polad J, Ijsselmuiden S, Cambero MM, Smits PC. Comparison of Supraflex Cruz 60 μm Versus Ultimaster Tansei 80 μm Stent Struts in High Bleeding Risk PCI Patients: Study design and Rational of Compare 60/80 HBR trial. Am J Cardiol 2023; 206:230-237. [PMID: 37708755 DOI: 10.1016/j.amjcard.2023.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023]
Abstract
Up to 45% of patients who underwent percutaneous coronary intervention (PCI) may have a high bleeding risk (HBR), depending on the bleeding risk definition.1 This condition is often associated with an enhanced risk of thrombotic events with a negative impact on short- and long-term outcomes,2-8 making the choice of an appropriate antithrombotic regimen after PCI particularly challenging. Advances in stent technologies, in which the introduction of newer generations of thinner strut drug-eluting stents (DES), have significantly reduced the rate of thrombotic complications and may justify a shorter dual antiplatelet therapy (DAPT) duration. Both in vitro and in vivo studies have shown that local hemodynamic factors may critically affect the natural history of atherosclerosis. Strut thickness correlates with flow disturbances and endothelial shear stress. Flow separation within struts determines areas of recirculation with low endothelial shear stress which promotes local concentration of activated platelets.9 By mitigating inflammation, vessel injury, and neointimal proliferation, thin and streamlined struts have been associated with faster vascular healing and re-endothelization and have resulted in lower rates of thrombotic events after PCI.10,11 The use of thin strut and ultra-thin strut stents may lead to a favorable trade-off in bleeding and ischemic events in patients with HBR. However, dedicated studies evaluating the performance of thin strut versus ultrathin strut stents in patients with HBR are lacking.
Collapse
Affiliation(s)
- Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands; Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Matteo Maurina
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; XXX, Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Sjoerd H Hofma
- Department of Cardiology, Medical Centrum Leeuwarden, The Netherlands
| | - Jeroen Vos
- Department of Cardiology, Amphia Hospital, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Rohit M Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Amar Al Mafragi
- Department of Cardiology, Zorgsaam Hospital, Terneuzen, The Netherlands
| | - Fabrizio Spano
- Department of Cardiology, Meander Hospital, Amersfoort, The Netherlands
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | | | | | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands.
| |
Collapse
|
2
|
Laudani C, Capodanno D, Angiolillo DJ. Bleeding in acute coronary syndrome: from definitions, incidence, and prognosis to prevention and management. Expert Opin Drug Saf 2023; 22:1193-1212. [PMID: 38048099 DOI: 10.1080/14740338.2023.2291865] [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: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In patients with acute coronary syndrome (ACS), the ischemic benefit of antithrombotic treatment is counterbalanced by the risk of bleeding. The recognition that bleeding events have prognostic implications (i.e. mortality) similar to recurrent ischemic events led to the development of treatment regimens aimed at balancing both ischemic and bleeding risks. AREAS COVERED This review aims at describing definitions, incidence, and prognosis related to bleeding events in ACS patients as well as bleeding-avoidance strategies for their prevention and management of bleeding complications. EXPERT OPINION Management of ACS patients has witnessed remarkable progress after the shift in focusing on the trade-off between ischemia and bleeding. Efforts in standardizing bleeding definitions will allow for better defining the prognostic impact of different types of bleeding events and enable to identify the high-bleeding risk patient. Such efforts will allow to balance the trade-off between the thrombotic and bleeding risk of the individual patient translating into better downward diagnostic and therapeutic decision-making. Novel strategies aiming at maximizing the safety and efficacy of antithrombotic regimens as well as the development of novel antithrombotic drugs and reversal agents and technological advances will allow for optimization of bleeding-avoidance strategies and management of bleeding complications.
Collapse
Affiliation(s)
- Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | | |
Collapse
|
3
|
Muacevic A, Adler JR, Tomanguillo J, Campbell JR, Kemper S, Naravadi VVR. Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS). Cureus 2023; 15:e34263. [PMID: 36855492 PMCID: PMC9968416 DOI: 10.7759/cureus.34263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/29/2023] Open
Abstract
Introduction Cardiac catheterization is an essential component of patient care in Acute Coronary Syndrome (ACS). Fecal occult blood testing (FOBT) has been used in the inpatient setting to evaluate the risk of bleeding with dual anti-platelet therapy prior to cardiac catheterization although no guidelines exist for this indication and FOBT testing in the inpatient setting is not recommended for evaluation of GI blood loss. We sought to assess the outcomes of patients with fecal occult positive stool prior to cardiac catheterization compared to those that did not undergo FOBT during admission for non-ST-elevation myocardial infarction (NSTEMI). Methods We identified patients between 18 and 90 years old with admission for NSTEMI in the Trinetx Research Network from January 1, 2019 to December 31, 2020. Patients were then divided into those who had an FOBT prior to cardiac catheterization and those that did not have an FOBT. We compared all-cause mortality, bleeding, troponin levels, and length of stay between propensity-matched (PSM) pairs of patients. Results We identified 46,349 that met inclusion criteria, of which 1,728 had an FOBT (3.7%) and 44,621 (96.3%) had no FOBT prior to cardiac catheterization. Patients in the FOBT group were older and had a higher prevalence of hypertension, coronary artery disease, heart failure, diabetes, chronic obstructive pulmonary disease, and higher BMI. Two well-matched groups of n=1,728/1,728 were used for comparing outcomes. The FOBT group had similar 30-day mortality (4.45% vs 4.01, P=0.56) as well as similar bleeding events (0.98% vs 0.69%, P=0.35). Troponin levels in the FOBT group were on average lower (0.41 vs 0.95, P=0.04). The FOBT groups also had a similar average length of stay of (14.1 days vs 14.2 days, P=0.42). 233 patients who received FOBT underwent endoscopic evaluation with either upper endoscopy or colonoscopy (13.5%), and there was no significant difference in 30-day mortality (6.86% vs 4.7%, P=0.321). Among patients who underwent endoscopy, 72 had some form of endoscopic intervention (30.9%). There was no difference in 30-day mortality between patients undergoing endoscopy with intervention and without intervention (14.49%/14.49%) P=1.00. Readmission was similar between patients undergoing endoscopy with and without intervention. Conclusions In a large multi-center national database, we observed similar outcomes in patients who were admitted with NSTEMI and had FOBT and those not receiving FOBT in terms of all-cause mortality and bleeding events. In patients with positive FOBT, endoscopy with and without intervention we observed no significant difference in 30-day mortality. We conclude that there is no compelling evidence for FOBT testing in patients with NSTEMI.
Collapse
|
4
|
Gragnano F, Spirito A, Corpataux N, Vaisnora L, Galea R, Gargiulo G, Siontis G, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Bär S, Ueki Y, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L, Valgimigli M. Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the ARC-HBR definition. EUROINTERVENTION 2021; 17:e898-e909. [PMID: 34105513 PMCID: PMC9725019 DOI: 10.4244/eij-d-21-00181] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The identification of bleeding risk factors in patients undergoing percutaneous coronary intervention (PCI) is essential to inform subsequent management. Whether clinical presentation per se affects bleeding risk after PCI remains unclear. AIMS We aimed to assess whether clinical presentation per se predisposes to bleeding in patients undergoing PCI and if the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria perform consistently in acute (ACS) and chronic (CCS) coronary syndrome patients. METHODS Consecutive patients undergoing PCI from the Bern PCI Registry were stratified by clinical presentation. Bleeding events at one year were compared in ACS versus CCS patients, and the originally defined ARC-HBR criteria were assessed. RESULTS Among 16,821 patients, 9,503 (56.5%) presented with ACS. At one year, BARC 3 or 5 bleeding occurred in 4.97% and 3.60% of patients with ACS and CCS, respectively. After adjustment, ACS remained associated with higher BARC 3 or 5 bleeding risk (adjusted HR 1.21, 95% CI: 1.01-1.43; p=0.034), owing to non-access site-related occurrences, which accrued mainly within the first 30 days after PCI. The ARC-HBR score had lower discrimination among ACS compared with CCS patients, and its performance slightly improved when ACS was computed as a minor criterion. CONCLUSIONS ACS presentation per se predicts one-year major bleeding risk after PCI. The ARC-HBR score discrimination appeared lower in ACS than CCS, and its overall performance improved numerically when ACS was computed as an additional minor risk criterion.
Collapse
Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Alessandro Spirito
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland,University Heart Center Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Lukas Vaisnora
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - George Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, and Azienda Ospedaliero Universitaria Policlinico “G. Rodolico – San Marco”, University of Catania, Catania, Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dik Heg
- Clinical Trials Unit (CTU) Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| |
Collapse
|
5
|
Guduguntla V, Redberg RF. Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease. Eur J Intern Med 2021; 94:15-21. [PMID: 34535375 DOI: 10.1016/j.ejim.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 01/09/2023]
Abstract
Despite limited benefit, percutaneous coronary intervention (PCI) remains a common procedure that is often performed for uncertain or inappropriate indications in patients with stable coronary artery disease (CAD). PCI cases per capita have increased year-over-year in most European countries, and many have higher rates than the U.S. Meanwhile, first-line therapy such as optimal medical therapy (OMT) and lifestyle changes, continue to be under-utilized. This article reviews the evidence on use of PCI in stable CAD. Specifically, we analyzed randomized control trials, systematic reviews, appropriate use criteria, and professional society guidelines that examine the risks and benefits of PCI compared to OMT. We then highlight utilization patterns as well as interventions that better align current practice with evidence-based care.
Collapse
Affiliation(s)
- Vinay Guduguntla
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94131, United States.
| | - Rita F Redberg
- Department of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94131, United States
| |
Collapse
|
6
|
Ng AKY, Ng PY, Ip A, Jim MH, Siu CW. Association Between Radial Versus Femoral Access for Percutaneous Coronary Intervention and Long-Term Mortality. J Am Heart Assoc 2021; 10:e021256. [PMID: 34325533 PMCID: PMC8475672 DOI: 10.1161/jaha.121.021256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long‐term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory‐wide retrospective cohort study including 26 022 patients who underwent first‐ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all‐cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all‐cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63–0.78; P<0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73–0.83, P<0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70–0.87, P<0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68–0.85, P<0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82–1.13, P=0.655). Conclusions Radial access was associated with a significant reduction in all‐cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.
Collapse
Affiliation(s)
| | - Pauline Yeung Ng
- Department of Adult Intensive Care Queen Mary Hospital Hong Kong SAR, China.,Division of Respiratory and Critical Care Medicine Department of Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR, China
| | - April Ip
- Division of Respiratory and Critical Care Medicine Department of Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR, China
| | - Man-Hong Jim
- Cardiac Medical Unit Grantham Hospital Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine Queen Mary HospitalThe University of Hong Kong Hong Kong SAR, China
| |
Collapse
|
7
|
Santoro C, Capone V, Canonico ME, Gargiulo G, Esposito R, Sanna GD, Parodi G, Esposito G. Single, Dual, and Triple Antithrombotic Therapy in Cancer Patients with Coronary Artery Disease: Searching for Evidence and Personalized Approaches. Semin Thromb Hemost 2021; 47:950-961. [PMID: 34261150 DOI: 10.1055/s-0041-1726298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Improvement in life expectancy of patients suffering from oncohematologic disorders has turned cancer from an acute into a chronic condition, making the management of comorbidities problematic, especially when it comes to both acute and chronic cardiovascular diseases. Treatment-related adverse events and drug-drug interactions often influence the therapeutic approach of patients with active malignancies and cardiovascular disease. Furthermore, tumor cells and platelets maintain a complex crosstalk that on one hand enhances tumor dissemination and on the other hand induces hemostasis abnormalities. Hence, clinicians should move carefully in the intricate land mines established by patients with active cancer under antithrombotic therapy. To date, there is no consensus on the antithrombotic treatment of patients with cardiovascular diseases and concomitant malignancies. The aim of this review is to collect the available scientific evidence, including the latest clinical trials and guidelines, in order to provide guidance on the management of antithrombotic treatment (both antiplatelet and anticoagulant therapy) in cancer patients with either pre-existent or new-onset coronary artery disease. Randomized-controlled trials on antithrombotic treatment in oncologic populations, which by far have thus far been excluded, have to be promoted to supply recommendations in the oncohematologic setting.
Collapse
Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Valentina Capone
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.,Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| |
Collapse
|
8
|
Kodaira M, Sawano M, Tanaka M, Kuno T, Numasawa Y, Ueda I, Fukuda K, Kohsaka S. Female sex as an independent predictor of high bleeding risk among East Asian percutaneous coronary intervention patients: A sex difference analysis. J Cardiol 2021; 78:431-438. [PMID: 34172350 DOI: 10.1016/j.jjcc.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sex differences in the outcomes following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have been identified in Western countries. However, data on the long-term outcomes for bleeding events, particularly in East Asia where the aging population is growing rapidly and consists predominantly of women, remain scarce. METHODS We analyzed 2,494 ACS survivors from a multicenter PCI registry who underwent PCI between 2009 and 2012. The primary outcome was readmission for major bleeding at 2 years. Survival curves were generated with the cumulative incidence function. The adjusted hazard ratios were evaluated for the primary outcomes by sex using (1) Fine-Gray models and (2) Cox regression models. RESULTS There were 548 women (22.0%) in this cohort. The women were older (73.7 ± 10.8 years vs. 65.4 ± 11.8 years, p < 0.001), had a lower body mass index (23.0 ± 3.9 vs. 24.3 ± 3.6, p < 0.001), and had more comorbidities such as renal failure (49.4% vs. 36.3%, p < 0.001) and previous heart failure (8.4% vs. 4.5%, p < 0.001). Fewer women were discharged with statins (81.9% vs. 86.5%, p = 0.025) or beta blockers (70.6% vs. 77.1%, p = 0.007). During the 2-year follow-up, the unadjusted readmission rates for bleeding were higher among women (4.9% versus 2.4% at 2 years after discharge). Multivariable competing risk analysis with the Fine-Gray model and Cox regression model further demonstrated that female sex was associated with a higher risk of bleeding. CONCLUSIONS Among patients treated with PCI, women had a higher incidence of bleeding events requiring readmission. Sex disparities in the etiologies of readmission following PCI suggest the need for targeted treatment strategies. A strict follow-up after discharge could be beneficial for women to further reduce their risk.
Collapse
Affiliation(s)
- Masaki Kodaira
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan.
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Tanaka
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Spirito A, Gragnano F, Corpataux N, Vaisnora L, Galea R, Svab S, Gargiulo G, Siontis GCM, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L, Valgimigli M. Sex-Based Differences in Bleeding Risk After Percutaneous Coronary Intervention and Implications for the Academic Research Consortium High Bleeding Risk Criteria. J Am Heart Assoc 2021; 10:e021965. [PMID: 34098740 PMCID: PMC8477884 DOI: 10.1161/jaha.121.021965] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Female sex was not included among the high bleeding risk (HBR) criteria by the Academic Research Consortium (ARC) as it remains unclear whether it constitutes an HBR condition after percutaneous coronary intervention. We investigated whether female sex associates with HBR and assessed the performance of ARC HBR criteria separately in women and men. Methods and Results Among all consecutive patients undergoing percutaneous coronary intervention between 2009 and 2018, bleeding occurrences up to 1 year were prospectively collected and centrally adjudicated. All but one of the originally defined ARC HBR criteria were assessed, and the ARC HBR score generated accordingly. Among 16 821 patients, 25.6% were women. Compared with men, women were older and had lower creatinine clearance and hemoglobin values. After adjustment, female sex was independently associated with access‐site (adjusted hazard ratio, 2.14; 95% CI, 1.22–3.74; P=0.008) but not with overall or non–access‐site 1‐year Bleeding Academic Research Consortium 3 or 5 bleeding. This association remained consistent when the femoral but not the radial approach was chosen. The ARC HBR score discrimination, using the original criteria, was lower among women than men (c‐index 0.644 versus 0.688; P=0.048), whereas a revised ARC HBR score, in which age, creatinine clearance, and hemoglobin were modeled as continuous rather than dichotomized variables, performed similarly in both sexes. Conclusions Female sex is an independent predictor for access‐site bleeding but not for overall bleeding events at 1 year after percutaneous coronary intervention. The ARC HBR framework shows an overall good performance in both sexes, yet is lower in women than men, attributable to dichotomization of age, creatinine clearance, and hemoglobin values, which are differently distributed between sexes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
Collapse
Affiliation(s)
| | - Felice Gragnano
- Department of Cardiology Bern University Hospital Bern Switzerland.,Division of Cardiology Department of Translational Medicine University of Campania "Luigi Vanvitelli Caserta Italy
| | - Noé Corpataux
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Lukas Vaisnora
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Roberto Galea
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefano Svab
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | | | - Fabien Praz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Jonas Lanz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | | | - Lukas Hunziker
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefan Stortecky
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Thomas Pilgrim
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Davide Capodanno
- Division of Cardiology Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania Catania Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine London United Kingdom
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Dik Heg
- Clinical Trial Unit Bern University of Bern Switzerland
| | | | - Lorenz Räber
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland.,Istituto Cardiocentro Ticino Ente Ospedaliero Cantonale Lugano Switzerland
| |
Collapse
|
10
|
Kwok CS, Wong CW, Kontopantelis E, Barac A, Brown SA, Velagapudi P, Hilliard AA, Bharadwaj AS, Chadi Alraies M, Mohamed M, Bhatt DL, Mamas MA. Percutaneous coronary intervention in patients with cancer and readmissions within 90 days for acute myocardial infarction and bleeding in the USA. Eur Heart J 2021; 42:1019-1034. [PMID: 33681960 DOI: 10.1093/eurheartj/ehaa1032] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/13/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023] Open
Abstract
AIMS The post-discharge outcomes of patients with cancer who undergo PCI are not well understood. This study evaluates the rates of readmissions within 90 days for acute myocardial infarction (AMI) and bleeding among patients with cancer who undergo percutaneous coronary intervention (PCI). METHODS AND RESULTS Patients treated with PCI in the years from 2010 to 2014 in the US Nationwide Readmission Database were evaluated for the influence of cancer on 90-day readmissions for AMI and bleeding. A total of 1 933 324 patients were included in the analysis (2.7% active cancer, 6.8% previous history of cancer). The 90-day readmission for AMI after PCI was higher in patients with active cancer (12.1% in lung, 10.8% in colon, 7.5% in breast, 7.0% in prostate, and 9.1% for all cancers) compared to 5.6% among patients with no cancer. The 90-day readmission for bleeding after PCI was higher in patients with active cancer (4.2% in colon, 1.5% in lung, 1.4% in prostate, 0.6% in breast, and 1.6% in all cancer) compared to 0.6% among patients with no cancer. The average time to AMI readmission ranged from 26.7 days for lung cancer to 30.5 days in colon cancer, while the average time to bleeding readmission had a higher range from 38.2 days in colon cancer to 42.7 days in breast cancer. CONCLUSIONS Following PCI, patients with cancer have increased risk for readmissions for AMI or bleeding, with the magnitude of risk depending on both cancer type and the presence of metastasis.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Ana Barac
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC, USA
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony A Hilliard
- Department of Medicine, Division of Cardiology, Linda University School of Medicine, Loma Linda, CA, USA
| | - Aditya S Bharadwaj
- Department of Medicine, Division of Cardiology, Linda University School of Medicine, Loma Linda, CA, USA
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit Heart Hospital, MI, USA
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| |
Collapse
|
11
|
Monlezun DJ, Lawless S, Palaskas N, Peerbhai S, Charitakis K, Marmagkiolis K, Lopez-Mattei J, Mamas M, Iliescu C. Machine Learning-Augmented Propensity Score Analysis of Percutaneous Coronary Intervention in Over 30 Million Cancer and Non-cancer Patients. Front Cardiovasc Med 2021; 8:620857. [PMID: 33889598 PMCID: PMC8055825 DOI: 10.3389/fcvm.2021.620857] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is unknown to what extent the clinical benefits of PCI outweigh the risks and costs in patients with vs. without cancer and within each cancer type. We performed the first known nationally representative propensity score analysis of PCI mortality and cost among all eligible adult inpatients by cancer and its types. Methods: This multicenter case-control study used machine learning–augmented propensity score–adjusted multivariable regression to assess the above outcomes and disparities using the 2016 nationally representative National Inpatient Sample. Results: Of the 30,195,722 hospitalized patients, 15.43% had a malignancy, 3.84% underwent an inpatient PCI (of whom 11.07% had cancer and 0.07% had metastases), and 2.19% died inpatient. In fully adjusted analyses, PCI vs. medical management significantly reduced mortality for patients overall (among all adult inpatients regardless of cancer status) and specifically for cancer patients (OR 0.82, 95% CI 0.75–0.89; p < 0.001), mainly driven by active vs. prior malignancy, head and neck and hematological malignancies. PCI also significantly reduced cancer patients' total hospitalization costs (beta USD$ −8,668.94, 95% CI −9,553.59 to −7,784.28; p < 0.001) independent of length of stay. There were no significant income or disparities among PCI subjects. Conclusions: Our study suggests among all eligible adult inpatients, PCI does not increase mortality or cost for cancer patients, while there may be particular benefit by cancer type. The presence or history of cancer should not preclude these patients from indicated cardiovascular care.
Collapse
Affiliation(s)
- Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sean Lawless
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shareez Peerbhai
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Konstantinos Charitakis
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | | | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Department of Cardiology, Royal Stroke Hospital Stoke on Trent, Stoke-on-Trent, United Kingdom
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
12
|
Hashimoto R, Numasawa Y, Yokokura S, Daigo K, Sakata S, Imaeda S, Hitomi Y, Sato K, Taruoka A, Haginiwa S, Kojima H, Tanaka M, Kuno T, Kodaira M. Prevalence of the Academic Research Consortium high bleeding risk criteria in patients undergoing endovascular therapy for peripheral artery disease in lower extremities. Heart Vessels 2021; 36:1350-1358. [PMID: 33651134 DOI: 10.1007/s00380-021-01813-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
The Academic Research Consortium (ARC) recently published a definition of patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention. However, the prevalence of the ARC-HBR criteria in patients undergoing endovascular therapy (EVT) for peripheral artery disease in lower extremities has not been thoroughly investigated. This study sought to investigate the prevalence and impact of the ARC-HBR criteria in patients undergoing EVT. We analyzed 277 consecutive patients who underwent their first EVT from July 2011 to September 2019. We applied the full ARC-HBR criteria to the study population. The primary end point was a composite outcome of all-cause mortality, Bleeding Academic Research Consortium 3 or 5 bleeding, and lower limb amputation within 12 months of EVT. Among the 277 patients, 193 (69.7%) met the ARC-HBR criteria. HBR patients had worse clinical outcomes compared with non-HBR patients at 12 months after EVT, including a higher incidence of the composite primary outcome (19.2% vs. 3.6%, p < 0.001) and all-cause death (7.8% vs. 0%, p = 0.007). In a multivariate Cox proportional hazards regression analysis, presence of the ARC-HBR criteria [hazard ratio (HR) 4.15, 95% confidence interval (CI) 1.25-13.80, p = 0.020], body mass index (HR 1.13, 95% CI 1.01-1.27, p = 0.042), diabetes mellitus (HR 2.70, 95% CI 1.28-5.69, p = 0.009), hyperlipidemia (HR 0.41, 95% CI 0.21-0.80, p = 0.009), and infrapopliteal lesions (HR 3.51, 95% CI 1.63-7.56, p = 0.001) were independent predictors of the primary composite outcome. Approximately 70% of Japanese patients undergoing EVT met the ARC-HBR criteria, and its presence was strongly associated with adverse outcomes within 12 months of EVT.
Collapse
Affiliation(s)
- Ryota Hashimoto
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan.,Department of Cardiovascular Medicine, Dokkyo Medical University Hospital, Mibu, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan.
| | - Souichi Yokokura
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Kyohei Daigo
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Shingo Sakata
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Shohei Imaeda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Yasuhiro Hitomi
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Kazuki Sato
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Akira Taruoka
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Sho Haginiwa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Hidenori Kojima
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Makoto Tanaka
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan.,Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan.,Department of Cardiology, McGill University, Montreal, Canada
| |
Collapse
|
13
|
Hishikari K, Hikita H, Abe F, Ito N, Kanno Y, Iiya M, Murai T, Takahashi A, Yonetsu T, Sasano T. Risk factors and prognostic impact of post-discharge bleeding after endovascular therapy for peripheral artery disease. Vasc Med 2021; 26:281-287. [PMID: 33645340 DOI: 10.1177/1358863x21992863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study evaluated the incidence, predictors, and impact of bleeding requiring hospitalization following successful endovascular therapy (EVT) for peripheral artery disease. Platelet inhibition after EVT reduces the risk of major adverse limb events but increases the risk of bleeding. The incidence of post-discharge bleeding after EVT, its independent predictors, and its prognostic importance in clinical practice have not been fully addressed. We evaluated 779 consecutive patients who underwent EVT. We found that 77 patients (9.9%) were hospitalized for major bleeding during follow-up after EVT (median 39 months, range 22-66 months), with almost half (48.1%) of the bleeding categorized as gastrointestinal bleeding. Significant predictors of post-discharge bleeding were hemodialysis (hazard ratio (HR), 3.12; 95% CI: 1.93 to 5.05; p < 0.001) and dual antiplatelet therapy (DAPT) use (HR, 1.87; 95% CI: 1.03 to 3.41; p = 0.041). During follow-up, the all-cause mortality-free survival rate was significantly worse in patients who had experienced major bleeding than in those who had not (log-rank test χ2 = 54.6; p < 0.001). Cox proportional hazards analysis showed that major bleeding (HR, 2.78; 95% CI: 1.90 to 4.06; p < 0.001) was an independent predictor of all-cause death after EVT. Hospitalization for post-discharge bleeding after EVT is associated with a substantially increased risk of death, even after successful EVT. We concluded that patients' predicted bleeding risk should be considered when selecting patients likely to benefit from EVT, and that the risk should be considered especially thoroughly in hemodialysis patients.
Collapse
Affiliation(s)
- Keiichi Hishikari
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.,Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Hikita
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Fumichika Abe
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Naruhiko Ito
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yoshinori Kanno
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Munehiro Iiya
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Tadashi Murai
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
14
|
Handa Y, Fukushima S, Osawa M, Murao T, Handa O, Matsumoto H, Umegaki E, Shiotani A. P2Y12 Inhibitors Exacerbate Low-dose Aspirin-induced Small Bowel Injury in Dual Antiplatelet Therapy. Intern Med 2021; 60:3517-3523. [PMID: 34776464 PMCID: PMC8666225 DOI: 10.2169/internalmedicine.7292-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Antithrombotic drugs are being used increasingly frequently to prevent cardiovascular diseases. Few studies have evaluated small bowel mucosal injury induced by dual antiplatelet therapy (DAPT). The aim of the present study was to evaluate small bowel mucosal injury induced by DAPT compared with other antithrombotics using video capsule endoscopy (VCE). Methods The study included chronic users of antithrombotics who underwent VCE for obscure gastrointestinal bleeding between January 2007 and July 2018. We evaluated the instances of small bowel injury classified into erosions and ulcers. Results Overall, 183 patients (114 men and 69 women; mean age, 73.6 years old) were enrolled, and the study groups comprised 49 patients taking low-dose aspirin (LDA) only, 50 taking anticoagulants only, 37 being treated with DAPT, 33 on combined LDA and anticoagulants, and 14 taking P2Y12 inhibitors. Small bowel erosions and ulcers were most frequently observed in the DAPT group, with frequencies of 78.4% and 37.8%, respectively. Exacerbating factors of small bowel ulcers were DAPT [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.2-7.7] and age over 80 years old (OR 2.4, 95% CI 1.1-5.4). Conclusion P2Y12 inhibitors seem to exacerbate LDA-induced small bowel injury. Preventive strategies for small bowel injury induced by LDA, especially DAPT, are urgently required.
Collapse
Affiliation(s)
- Yukiko Handa
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Shinya Fukushima
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Motoyasu Osawa
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Takahisa Murao
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Osamu Handa
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Hiroshi Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Japan
| |
Collapse
|
15
|
Tung YC, See LC, Chang SH, Liu JR, Kuo CT, Chang CJ. Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease. Sci Rep 2020; 10:21345. [PMID: 33288822 PMCID: PMC7721794 DOI: 10.1038/s41598-020-78400-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Abstract
This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS.
Collapse
Affiliation(s)
- Ying-Chang Tung
- Cardiovascular Department, Linkou Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan Dist., Taoyuan City, 33305, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan, ROC.,Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shu-Hao Chang
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Tai Kuo
- Cardiovascular Department, Linkou Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan Dist., Taoyuan City, 33305, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Jen Chang
- Cardiovascular Department, Linkou Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan Dist., Taoyuan City, 33305, Taiwan, ROC. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
| |
Collapse
|
16
|
Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J 2020; 40:2632-2653. [PMID: 31116395 PMCID: PMC6736433 DOI: 10.1093/eurheartj/ehz372] [Citation(s) in RCA: 309] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Identification and management of patients at high bleeding risk undergoing percutaneous
coronary intervention are of major importance, but a lack of standardization in defining
this population limits trial design, data interpretation, and clinical decision-making.
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among
leading research organizations, regulatory authorities, and physician-scientists from the
United States, Asia, and Europe focusing on percutaneous coronary intervention–related
bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April
2018 and in Paris, France, in October 2018. These meetings were organized by the
Cardiovascular European Research Center on behalf of the ARC-HBR group and included
representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals
and Medical Devices Agency, as well as observers from the pharmaceutical and medical
device industries. A consensus definition of patients at high bleeding risk was developed
that was based on review of the available evidence. The definition is intended to provide
consistency in defining this population for clinical trials and to complement clinical
decision-making and regulatory review. The proposed ARC-HBR consensus document represents
the first pragmatic approach to a consistent definition of high bleeding risk in clinical
trials evaluating the safety and effectiveness of devices and drug regimens for patients
undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
- Philip Urban
- La Tour Hospital, Geneva, Switzerland.,Cardiovascular European Research Center, Massy, France
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Germany
| | | | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy.,Azienda Ospedaliero Universitario "Vittorio Emanuele-Policlinico," University of Catania, Italy
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de recherche en cardiovasculaire et nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD
| | - C Michael Gibson
- Harvard Medical School, Boston, MA.,Baim Institute for Clinical Research, Brookline, MA
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Korea
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY.,Cardiovascular Research Foundation, New York, NY
| | | | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway
| | | | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands
| | | | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance publique - hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris-Cité, France
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Durham, NC.,Duke University Medical Center, Durham, NC
| | | |
Collapse
|
17
|
Gellatly RM, Connell C, Tan C, Andrianopoulos N, Ajani AE, Clark DJ, Nanayakkara S, Sebastian M, Brennan A, Freeman M, O'Brien J, Selkrig LA, Reid CM, Duffy SJ. Trends of Use and Outcomes Associated With Glycoprotein-IIb/IIIa Inhibitors in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Ann Pharmacother 2019; 54:414-422. [PMID: 31766865 DOI: 10.1177/1060028019889550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Glycoprotein IIb/IIIa inhibitors (GPIs) are a treatment option in the management of acute coronary syndromes (ACSs). Evidence supporting the use of GPIs predates trials establishing the benefits of P2Y12 inhibitors, routine early invasive therapy, and thrombectomy devices in patients with ACS. Objective: The aim of this study was to determine trends in GPI use and their associated outcomes in contemporary practice. Methods: We assessed GPI use in patients with ACS undergoing percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry (2005-2013). The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACE). The safety endpoint was in-hospital major bleeding. Results: GPIs were used in 40.5% of 12 357 patients with ACS undergoing PCI. GPI use decreased over the study period (P for trend <0.0001). Patients were more likely to receive GPIs if they were younger, presented with a ST-elevation myocardial infarction (STEMI), had more complex (B2/C-type) lesions, and when thrombectomy devices were used (all P < 0.0001). MACE were higher in patients receiving GPI (4.9% vs 4.1%, P = 0.03). Propensity score matching revealed no difference in 30-day mortality and 30-day MACE (odds ratio [OR] = 1.00; 95% CI = 0.99-1.004 and OR = 1.01; 95% CI = 0.99-1.02, respectively). GPI use was associated with more bleeding complications (3.6% vs 1.8%, P < 0.0001). Conclusion and Relevance: GPI use in ACS patients undergoing PCI has declined, and use appears to be dictated by ACS type and lesion complexity, as opposed to high-risk comorbidities. GPI use was associated with a doubling in bleeding complications.
Collapse
Affiliation(s)
| | - Cia Connell
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Andrew E Ajani
- Monash University, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | - Stephen J Duffy
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Ismail N, Jordan KP, Kadam UT, Edwards JJ, Kinnaird T, Mamas MA. Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors. J Am Heart Assoc 2019; 8:e013679. [PMID: 31657257 PMCID: PMC6898798 DOI: 10.1161/jaha.119.013679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome. Methods and Results We used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person‐years (95% CI, 157–167/1000 person‐years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event. Conclusions Bleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk‐benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy.
Collapse
Affiliation(s)
- Nafiu Ismail
- Centre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United Kingdom.,Keele Cardiovascular Research Group Keele University Staffordshire United Kingdom
| | - Kelvin P Jordan
- Centre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United Kingdom
| | - Umesh T Kadam
- Department of Health Sciences University of Leicester Leicester United Kingdom
| | - John J Edwards
- Centre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United Kingdom
| | - Tim Kinnaird
- Department of Cardiology University Hospital of Wales Cardiff Wales United Kingdom
| | - Mamas A Mamas
- Centre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United Kingdom.,Keele Cardiovascular Research Group Keele University Staffordshire United Kingdom
| |
Collapse
|
19
|
Cesaro A, Moscarella E, Gragnano F, Perrotta R, Diana V, Pariggiano I, Concilio C, Alfieri A, Cesaro F, Mercone G, Falato S, Esposito A, Di Girolamo D, Limongelli G, Calabrò P. Transradial access versus transfemoral access: a comparison of outcomes and efficacy in reducing hemorrhagic events. Expert Rev Cardiovasc Ther 2019; 17:435-447. [PMID: 31213156 DOI: 10.1080/14779072.2019.1627873] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: The radial artery is currently the most widely used access site for PCI procedures both acute and stable patient settings. Thanks to advantages in pharmacological therapy as well as in interventional devices, the rate of ischemic complications following PCI has significantly decreased. Nevertheless, this has been counterbalanced by an increased risk of periprocedural and late bleeding event, that can occur both at access and non-access sites. Choice of access site for PCI is of paramount importance to reduce the risk of access-related bleeding events. Areas covered: The aim of this review is to provide an overview of the actual available evidence comparing the transradial versus transfemoral approach to reduce hemorrhagic events. The most robust evidence comes from large randomized trials, partly also from observational registries, which compared the transradial and transfemoral approach. Expert opinion: Results show that radial access has proved to be decisive in reducing the incidence of hemorrhagic events. Furthermore, it showed a significant reduction in mortality and AKI compared to transfemoral access. However, increased experience in the use of the radial approach has led to less practice in the use of the femoral approach, which may be useful in cases of emergency, complications or inability to use the radial artery.
Collapse
Affiliation(s)
- Arturo Cesaro
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Elisabetta Moscarella
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Felice Gragnano
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Rocco Perrotta
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy
| | - Vincenzo Diana
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Ivana Pariggiano
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Claudia Concilio
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Alfonso Alfieri
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy
| | - Francesco Cesaro
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy
| | - Giuseppe Mercone
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy
| | - Sergio Falato
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Augusto Esposito
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Domenico Di Girolamo
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy
| | - Giuseppe Limongelli
- b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Paolo Calabrò
- a Division of Clinical Cardiology , A.O.R.N. "Sant'Anna e San Sebastiano" , Caserta , Italy.,b Department of Translational Medical Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| |
Collapse
|
20
|
Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants. J Cardiovasc Pharmacol 2019; 74:210-217. [PMID: 31306368 DOI: 10.1097/fjc.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score-matched pairs (hazard ratio 6.21, 95% confidence interval 3.29-11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68-14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.
Collapse
|
21
|
Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC. Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention. Circulation 2019; 140:240-261. [PMID: 31116032 PMCID: PMC6636810 DOI: 10.1161/circulationaha.119.040167] [Citation(s) in RCA: 417] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limits trial design, data interpretation, and clinical decision-making. The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among leading research organizations, regulatory authorities, and physician-scientists from the United States, Asia, and Europe focusing on percutaneous coronary intervention–related bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April 2018 and in Paris, France, in October 2018. These meetings were organized by the Cardiovascular European Research Center on behalf of the ARC-HBR group and included representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, as well as observers from the pharmaceutical and medical device industries. A consensus definition of patients at high bleeding risk was developed that was based on review of the available evidence. The definition is intended to provide consistency in defining this population for clinical trials and to complement clinical decision-making and regulatory review. The proposed ARC-HBR consensus document represents the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
- Philip Urban
- La Tour Hospital, Geneva, Switzerland (P.U.).,Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Germany (R.C., R.A.B.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (R.A.B.)
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti (D. Capodanno), Catania, Italy.,Azienda Ospedaliero Universitario "Vittorio Emanuele-Policlinico," University of Catania, Italy (D. Capodanno)
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de recherche en cardiovasculaire et nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France (T.C.)
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D. Cutlip)
| | - Pedro Eerdmans
- Head of the Notified Body, DEKRA Certification B.V. (P.E.)
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada (J.E.)
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - C Michael Gibson
- Baim Institute for Clinical Research, Brookline, MA (C.M.G.).,Harvard Medical School, Boston, MA (C.M.G.)
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK (J.G., S.P.)
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany (M.H.)
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (S.K.J.)
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T.K.)
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan (A.K., Y.M.)
| | - John Laschinger
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Martin B Leon
- Columbia University Medical Center, New York, NY (M.B.L.).,Cardiovascular Research Foundation, New York, NY (M.B.L.)
| | - P F Adrian Magee
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan (A.K., Y.M.)
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway (D.M.)
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, UK (J.G., S.P.)
| | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC (S.V.R., M.W.K.)
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (E.S.).,Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands (E.S.)
| | - Norman Stockbridge
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Switzerland (M.V.)
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance publique - hôpitaux de Paris, Paris, France (O.V.).,Université Paris Descartes, Sorbonne Paris-Cité, France (O.V.)
| | - Ute Windhoevel
- Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Durham, NC (S.V.R., M.W.K.).,Duke University Medical Center, Durham, NC (M.W.K.)
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
| |
Collapse
|
22
|
Ismail N, Jordan KP, Rao S, Kinnaird T, Potts J, Kadam UT, Mamas MA. Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review. BMJ Open 2019; 9:e023337. [PMID: 30787079 PMCID: PMC6398751 DOI: 10.1136/bmjopen-2018-023337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/19/2018] [Accepted: 01/23/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting. DESIGN A narrative systematic review. DATA SOURCE Medline, Embase, Amed and Central (Cochrane) were searched up to August 2018. STUDY SELECTION For the primary objective, randomised controlled trials (RCT) and observational studies reporting on the incidence of bleeding post hospital discharge were included. For the secondary objective, RCTs and observational studies that compared patients with bleeding versus those without bleeding post hospital discharge vis-à-vis mortality, MACE, myocardial re-infarction and rehospitalisation were included. RESULTS 53 studies (36 observational studies and 17 RCTs) with a combined cohort of 714 458 participants for the primary objectives and 187 317 for the secondary objectives were included. Follow-up ranged from 1 month to just over 4 years. The incidence of bleeding within 12 months post hospital discharge ranged from 0.20% to 37.5% in observational studies and between 0.96% and 39.4% in RCTs. The majority of bleeds occurred in the initial 3 months after hospital discharge with bruising the most commonly reported event. Major bleeding increased the risk of mortality by nearly threefold in two studies. One study showed an increased risk of MACE (HR 3.00,95% CI 2.75 to 3.27; p<0.0001) with bleeding and another study showed a non-significant association with rehospitalisation (HR 1.20,95% CI 0.95 to 1.52; p=0.13). CONCLUSION Bleeding complications following ACS management are common and continue to occur in the long term after hospital discharge. These bleeding complications may increase the risk of mortality and MACE, but greater evidence is needed to assess their long-term effects. PROSPERO REGISTRATION NUMBER CRD42017062378.
Collapse
Affiliation(s)
- Nafiu Ismail
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Sunil Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Jessica Potts
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Umesh T Kadam
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mamas A Mamas
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| |
Collapse
|
23
|
Potts JE, Iliescu CA, Lopez Mattei JC, Martinez SC, Holmvang L, Ludman P, De Belder MA, Kwok CS, Rashid M, Fischman DL, Mamas MA. Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J 2018; 40:1790-1800. [DOI: 10.1093/eurheartj/ehy769] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/25/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jessica E Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
| | - Cezar A Iliescu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Juan C Lopez Mattei
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, WA, USA
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark A De Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| |
Collapse
|
24
|
Wang L, Pei D, Ouyang YQ, Nie X. Meta-analysis of risk and protective factors for gastrointestinal bleeding after percutaneous coronary intervention. Int J Nurs Pract 2018; 25:e12707. [PMID: 30456863 DOI: 10.1111/ijn.12707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/30/2018] [Accepted: 10/05/2018] [Indexed: 01/22/2023]
Abstract
AIM To quantitatively analyse factors related to gastrointestinal bleeding after percutaneous coronary intervention and provide evidence for the prevention of gastrointestinal bleeding. DATA SOURCES AND REVIEW METHODS Cochrane Library, Pubmed, Embase, and Ovid databases were searched from inception to 31 May 2018; case-control and cohort studies published in English were included. The methodological quality of each study was assessed by two independent reviewers using the Newcastle-Ottawa Scale. Meta-analysis was performed using Revman version 5.3. RESULTS A total of 16 publications yielded data about risk factors. It was found that age older than 70 years, age (per 10-year increase), female sex, baseline anaemia, history of smoking, history of using alcohol, history of peptic ulcer disease, chronic renal failure, previous bleeding, shock, congestive heart failure, acute myocardial infarction, prior use of inotropic medications, and prior use of antithrombotic medications were positively associated with gastrointestinal bleeding. Four articles yielded data about protective factors. It was found that proton-pump inhibitor and bivalirudin therapy were negatively associated with gastrointestinal bleeding after percutaneous coronary intervention. CONCLUSION This research found risk and protective factors which can assist in effective management of this potentially fatal complication.
Collapse
Affiliation(s)
- Lan Wang
- School of Health Sciences of Wuhan University, Wuhan, China.,Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dajun Pei
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Xiaofei Nie
- School of Health Sciences of Wuhan University, Wuhan, China
| |
Collapse
|
25
|
Vidula MK, McCarthy CP, Butala NM, Kennedy KF, Wasfy JH, Yeh RW, Secemsky EA. Causes and predictors of early readmission after percutaneous coronary intervention among patients discharged on oral anticoagulant therapy. PLoS One 2018; 13:e0205457. [PMID: 30379868 PMCID: PMC6209191 DOI: 10.1371/journal.pone.0205457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
Patients discharged on oral anticoagulant (OAC) therapy after percutaneous coronary intervention (PCI) represent a complex population and are at higher risk of early readmission. The reasons and predictors of early readmission in this group have not been well characterized. We identified patients in an integrated health care system who underwent PCI between 2009 and 2014 and were readmitted within 30 days within this health care system. Of the 9,357 patients surviving to discharge after the index PCI, 692 were readmitted within 30 days (7.4%). At the time of readmission, 143 had been discharged from the index PCI hospitalization on OACs (96.5% on warfarin) and 549 had not been discharged on OACs, with readmission rates of 12.9% and 6.7%, respectively (p<0.01). The most common reason for readmission among all patients was chest pain syndromes (21.7% on OACs, 34.4% not on OACs). However, bleeding represented the next most frequent cause of readmission among patients on OACs (14.0% on OACs vs 6.0% not on OACs, p<0.01). Among patients on OAC therapy, peripheral arterial disease (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.07-2.57, p = 0.02) and nonelective PCI (OR 1.91, 95% CI 1.17-3.12, p<0.01) were found to be independent predictors of 30-day readmission. During rehospitalization, compared to patients not on OACs, patients on OACs suffered a higher unadjusted rate of mortality (6.3% vs 1.8%, p<0.01) and a longer length of stay (6.4 ± 7.1 days vs 4.9 ± 6.8 days, p = 0.02). In conclusion, patients discharged on OAC therapy after PCI are commonly readmitted, with bleeding representing a major reason. These readmissions are associated with high mortality and longer lengths of stay. Interventions targeted towards optimizing discharge planning for these complex patients are needed to potentially reduce readmissions.
Collapse
Affiliation(s)
- Mahesh K. Vidula
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Cian P. McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Neel M. Butala
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kevin F. Kennedy
- Saint Luke's Mid America Heart Institute/University of Missouri–Kansas City, Kansas City, Missouri, United States of America
| | - Jason H. Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Robert W. Yeh
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Eric A. Secemsky
- Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
26
|
Dual antiplatelet therapy versus single antiplatelet therapy after transaortic valve replacement: Meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:47-52. [DOI: 10.1016/j.carrev.2018.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 01/11/2023]
|
27
|
Wakabayashi S, Ariyoshi N, Kitahara H, Fujii K, Fujimoto Y, Kobayashi Y. Efficacy of 2.5-mg Prasugrel in Elderly or Low-Body-Weight Patients. Circ J 2018; 82:2326-2331. [DOI: 10.1253/circj.cj-18-0337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinichi Wakabayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Noritaka Ariyoshi
- Department of Personalized Medicine and Preventive Healthcare Sciences, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Kenichi Fujii
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| |
Collapse
|
28
|
Holm A, Lawesson SS, Zolfagharian S, Swahn E, Ekstedt M, Alfredsson J. Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective. Thromb Res 2018; 167:156-163. [PMID: 29857272 DOI: 10.1016/j.thromres.2018.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of the current study was to assess bleeding events, including severity, localisation and prognostic impact, in a real world population of men and women with myocardial infarction (MI). METHODS AND RESULTS In total 850 consecutive patients were included during 2010 and followed for one year. Bleeding complications were identified by searching of each patients' medical records and characterised according to the TIMI criteria. For this analysis, only the first event was calculated. The total incidence of bleeding events was 24.4% (81 women and 126 men, p = ns). The incidence of all in-hospital bleeding events was 13.2%, with no sex difference. Women had significantly more minor non-surgery related bleeding events than men (5% vs 2.2%, p = 0.02). During follow-up, 13.5% had a bleeding, with more non-surgery related bleeding events among women, 14.7% vs 9.7% (p = 0.03). The most common bleeding localisation was the gastrointestinal tract, more in women than men (12.1% vs 7.6%, p = 0.03). Women had also more access site bleeding complications (4% vs 1.7%, p = 0.04), while men had more surgery related bleeding complications (6.4% vs 0.9%, p ≤0.001). Increased mortality was found only in men with non-surgery related bleeding events (p = 0.008). CONCLUSIONS Almost one in four patients experienced a bleeding complication through 12 months follow-up after a myocardial infarction. Women experienced more non-surgery related minor/minimal bleeding complications than men, predominantly GI bleeding events and access site bleeding events, with no apparent impact on outcome. In contrast men with non-surgery related bleeding complications had higher mortality. Improved bleeding prevention strategies are warranted for both men and women.
Collapse
Affiliation(s)
- Anna Holm
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Eva Swahn
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Department of Gastroenterology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
29
|
Nakamura M, Iijima R, Ako J, Shinke T, Okada H, Ito Y, Ando K, Anzai H, Tanaka H, Ueda Y, Takiuchi S, Nishida Y, Ohira H, Kawaguchi K, Kadotani M, Niinuma H, Omiya K, Morita T, Zen K, Yasaka Y, Inoue K, Ishiwata S, Ochiai M, Hamasaki T, Yokoi H. Dual Antiplatelet Therapy for 6 Versus 18 Months After Biodegradable Polymer Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2018. [PMID: 28641838 DOI: 10.1016/j.jcin.2017.04.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The NIPPON (Nobori Dual Antiplatelet Therapy as Appropriate Duration) study was a multicenter randomized investigation of the noninferiority of short-term versus long-term dual antiplatelet therapy (DAPT) in patients with implantation of the Nobori drug-eluting stent (DES) (Terumo, Tokyo, Japan), which has a biodegradable abluminal coating. BACKGROUND The optimum duration of DAPT for patients with a biodegradable polymer-coated DES is unclear. METHODS The subjects were 3,773 patients with stable or acute coronary syndromes undergoing Nobori stent implantation. They were randomized 1:1 to receive DAPT for 6 or 18 months. The primary endpoint was net adverse clinical and cerebrovascular events (NACCE) (all-cause mortality, myocardial infarction, stroke, and major bleeding) from 6 to 18 months after stenting. Intention-to-treat analysis was performed in 3,307 patients who were followed for at least 6 months. RESULTS NACCE occurred in 34 patients (2.1%) receiving short-term DAPT and 24 patients (1.5%) receiving long-term DAPT (difference 0.6%, 95% confidence interval [CI]: 1.5 to 0.3). Because the lower limit of the 95% CI was inside the specified margin of -2%, noninferiority of short-term DAPT was confirmed. Mortality was 1.0% with short-term DAPT versus 0.4% with long-term DAPT, whereas myocardial infarction was 0.2% versus 0.1%, and major bleeding was 0.7% versus 0.7%, respectively. The estimated probability of NACCE was lower in the long-term DAPT group (hazard ratio: 1.44, 95% CI: 0.86 to 2.43). CONCLUSIONS Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).
Collapse
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Raisuke Iijima
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hitoshi Anzai
- Cardiology Department, Ota Memorial Hospital, Ota, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shin Takiuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Takai Hospital, Nara, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Makoto Kadotani
- Department of Cardiology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Hiroyuki Niinuma
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuto Omiya
- Division of Cardiology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Hyogo Brain and Heart Center, Himeji, Japan
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toshimitsu Hamasaki
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| |
Collapse
|
30
|
Valle JA, Shetterly S, Maddox TM, Ho PM, Bradley SM, Sandhu A, Magid D, Tsai TT. Postdischarge Bleeding After Percutaneous Coronary Intervention and Subsequent Mortality and Myocardial Infarction: Insights From the HMO Research Network-Stent Registry. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003519. [PMID: 27301394 DOI: 10.1161/circinterventions.115.003519] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bleeding after hospital discharge from percutaneous coronary intervention (PCI) is associated with increased risk of subsequent myocardial infarction (MI) and death; however, the timing of adverse events after these bleeding events is poorly understood. Defining this relationship may help clinicians identify critical periods when patients are at highest risk. METHODS AND RESULTS All patients undergoing PCI from 2004 to 2007 who survived to hospital discharge without a bleeding event were identified from the HMO Research Network-Stent (HMORN-Stent) Registry. Postdischarge rates and timing of bleeding-related hospitalizations, MI, and death were defined. We then assessed the association between postdischarge bleeding-related hospitalizations with death and MI using Cox proportional hazards models. Among 8137 post-PCI patients surviving to hospital discharge without in-hospital bleeding, 391 (4.8%) had bleeding-related hospitalization after discharge, with the highest incidence of bleeding-related hospitalizations occurring within 30 days of discharge (n=79, 20.2%). Postdischarge bleeding-related hospitalization after PCI was associated with subsequent death or MI (hazard ratio, 3.09; 95% confidence interval, 2.41-3.96), with the highest risk for death or MI occurring in the first 60 days after bleeding-related hospitalization (hazard ratio, 7.16; confidence interval, 3.93-13.05). CONCLUSIONS Approximately 1 in 20 post-PCI patients are readmitted for bleeding, with the highest incidence occurring within 30 days of discharge. Patients having postdischarge bleeding are at increased risk for subsequent death or MI, with the highest risk occurring within the first 60 days after a bleeding-related hospitalization. These findings suggest a critical period after bleeding events when patients are most vulnerable for further adverse events.
Collapse
Affiliation(s)
- Javier A Valle
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
| | - Susan Shetterly
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - Thomas M Maddox
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - Steven M Bradley
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - Amneet Sandhu
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - David Magid
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| | - Thomas T Tsai
- From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.)
| |
Collapse
|
31
|
Valle JA, Graham L, DeRussy A, Itani K, Hawn MT, Maddox TM. Triple Antithrombotic Therapy and Outcomes in Post-PCI Patients Undergoing Non-cardiac Surgery. World J Surg 2017; 41:423-432. [PMID: 27734083 DOI: 10.1007/s00268-016-3725-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown. METHODS We identified patients undergoing non-cardiac surgeries within 2 years of PCI in Veterans Affairs hospitals from 2004 to 2012. We compared perioperative major adverse cardiovascular and cerebrovascular events (MACCE: mortality, myocardial infarction, stroke, revascularization) and bleeding events (in-hospital bleeding, transfusion) between surgeries in patients prescribed triple therapy and DAPT, adjusting for clinical, demographic, and operative characteristics. RESULTS Among 7811 surgeries, 391 (5.0 %) occurred in patients receiving triple therapy. 44 (11.3 %) MACCE and 107 (27.4 %) bleeding events occurred with surgeries in triple therapy patients, compared to 366 (4.9 %) MACCE and 980 (13.2 %) bleeding events in DAPT patients. After adjustment, surgery in triple therapy patients was associated with higher rates of MACCE [odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.16-2.34] or bleeding (OR 1.52, 95 % CI 1.17-1.99) as compared to surgery in DAPT patients. CONCLUSIONS One in twenty post-PCI patients undergoing non-cardiac surgery were on triple therapy. Surgery in these patients was associated with higher MACCE and bleeding events compared to surgery in patients on DAPT, independent of clinical and operative characteristics. These findings identify a high-risk population for surgery, which may warrant increased surveillance for adverse perioperative events.
Collapse
Affiliation(s)
- Javier A Valle
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO, USA. .,Division of Cardiology, University of Colorado Hospital, 12631 E. 17th Street, B130, Aurora, CO, 80045, USA.
| | - Laura Graham
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Aerin DeRussy
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Kamal Itani
- Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, MA, USA
| | - Mary T Hawn
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO, USA
| |
Collapse
|
32
|
Brinkert M, Southern DA, James MT, Knudtson ML, Anderson TJ, Charbonneau F. Incidence and Prognostic Implications of Late Bleeding After Myocardial Infarction or Unstable Angina According to Treatment Strategy. Can J Cardiol 2017; 33:998-1005. [DOI: 10.1016/j.cjca.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022] Open
|
33
|
Gargiulo G, Santucci A, Piccolo R, Franzone A, Ariotti S, Baldo A, Esposito G, Moschovitis A, Windecker S, Valgimigli M. Impact of chronic kidney disease on 2-year clinical outcomes in patients treated with 6-month or 24-month DAPT duration: An analysis from the PRODIGY trial. Catheter Cardiovasc Interv 2017; 90:E73-E84. [DOI: 10.1002/ccd.26921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/19/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Department of Advanced Biomedical Sciences; Federico II University of Naples; Italy
| | - Andrea Santucci
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Raffaele Piccolo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Anna Franzone
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Sara Ariotti
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Andrea Baldo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences; Federico II University of Naples; Italy
| | - Aris Moschovitis
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| |
Collapse
|
34
|
Khoury H, Lavoie L, Welner S, Folkerts K. The Burden of Major Adverse Cardiac Events and Antiplatelet Prevention in Patients with Coronary or Peripheral Arterial Disease. Cardiovasc Ther 2017; 34:115-24. [PMID: 26670723 DOI: 10.1111/1755-5922.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patients with a history of a cardiovascular (CV) disease are at high risk of suffering secondary major adverse cardiac events (MACE), namely death, nonfatal myocardial infarction (MI), stroke, symptomatic pulmonary embolism, CV and all-cause hospitalization, and bleeding. METHODS A comprehensive review of the literature was conducted to review the epidemiology and burden of MACE in patients with coronary or peripheral arterial disease (CAD or PAD) in Europe and other ex-US regions. Relevant articles published between 2003 and 2013 were retrieved from PubMed and other sites. RESULTS MACE incidence and prevalence in patients with CAD or PAD were increased by at least 1.4-fold compared with matched controls with no CV disease. In patients with CAD, MACE mostly occurred within 30 days of primary percutaneous coronary intervention; incidence decreased with time. Increased oxidative stress in coronary and peripheral arteries, diabetes, and chronic kidney disease were identified as the main risk factors for MACE in patients with CAD and PAD. Registry data showed that, although preventive antiplatelet therapy was prescribed at high rates, a large proportion (9-56%) of patients did not receive treatment. Furthermore, adherence to treatment declined over time, potentially leading to disease worsening. CONCLUSION Despite gaps in the literature, this assessment showed that MACE's risk is substantial among patients with CAD or PAD and that the use of preventive therapies is suboptimal. Development of additional preventive therapies for these patients is warranted.
Collapse
|
35
|
Incidence and predictors of bleeding complications after percutaneous coronary intervention. J Cardiol 2017; 69:272-279. [DOI: 10.1016/j.jjcc.2016.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/01/2016] [Accepted: 05/02/2016] [Indexed: 02/03/2023]
|
36
|
Wang F, Gulati R, Lennon RJ, Lewis BR, Park J, Sandhu GS, Wright RS, Lerman A, Herrmann J. Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality After Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction. Mayo Clin Proc 2016; 91:1680-1692. [PMID: 27916154 DOI: 10.1016/j.mayocp.2016.06.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1%) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. RESULTS Patients with cancer had higher in-hospital noncardiac (1.9% vs 0.4%; P=.03) but similar cardiac (5.8% vs 4.6%; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95% CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2% vs 5.8%; HR=1.27; 95% CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15% vs 10%; HR=1.72; 95% CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0% vs 11.0%; HR=3.01; 95% CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. CONCLUSION One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.
Collapse
Affiliation(s)
- Feilong Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Bradley R Lewis
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jae Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
37
|
Chandrasekhar J, Baber U, Mehran R, Aquino M, Sartori S, Yu J, Kini A, Sharma S, Skurk C, Shlofmitz RA, Witzenbichler B, Dangas G. Impact of an integrated treatment algorithm based on platelet function testing and clinical risk assessment: results of the TRIAGE Patients Undergoing Percutaneous Coronary Interventions To Improve Clinical Outcomes Through Optimal Platelet Inhibition study. J Thromb Thrombolysis 2016; 42:186-96. [PMID: 27100112 DOI: 10.1007/s11239-016-1357-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Assessment of platelet reactivity alone for thienopyridine selection with percutaneous coronary intervention (PCI) has not been associated with improved outcomes. In TRIAGE, a prospective multicenter observational pilot study we sought to evaluate the benefit of an integrated algorithm combining clinical risk and platelet function testing to select type of thienopyridine in patients undergoing PCI. Patients on chronic clopidogrel therapy underwent platelet function testing prior to PCI using the VerifyNow assay to determine high on treatment platelet reactivity (HTPR, ≥230 P2Y12 reactivity units or PRU). Based on both PRU and clinical (ischemic and bleeding) risks, patients were switched to prasugrel or continued on clopidogrel per the study algorithm. The primary endpoints were (i) 1-year major adverse cardiovascular events (MACE) composite of death, non-fatal myocardial infarction, or definite or probable stent thrombosis; and (ii) major bleeding, Bleeding Academic Research Consortium type 2, 3 or 5. Out of 318 clopidogrel treated patients with a mean age of 65.9 ± 9.8 years, HTPR was noted in 33.3 %. Ninety (28.0 %) patients overall were switched to prasugrel and 228 (72.0 %) continued clopidogrel. The prasugrel group had fewer smokers and more patients with heart failure. At 1-year MACE occurred in 4.4 % of majority HTPR patients on prasugrel versus 3.5 % of primarily non-HTPR patients on clopidogrel (p = 0.7). Major bleeding (5.6 vs 7.9 %, p = 0.47) was numerically higher with clopidogrel compared with prasugrel. Use of the study clinical risk algorithm for choice and intensity of thienopyridine prescription following PCI resulted in similar ischemic outcomes in HTPR patients receiving prasugrel and primarily non-HTPR patients on clopidogrel without an untoward increase in bleeding with prasugrel. However, the study was prematurely terminated and these findings are therefore hypothesis generating.
Collapse
Affiliation(s)
- Jaya Chandrasekhar
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | - Melissa Aquino
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | - Jennifer Yu
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA
| | | | | | | | | | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY, USA. .,Mount Sinai Hospital, New York, NY, USA.
| |
Collapse
|
38
|
Belardi J, Manoharan G, Albertal M, Widimský P, Neumann FJ, Silber S, Leon MB, Saito S. The influence of age on clinical outcomes in patients treated with the resolute zotarolimus-eluting stent. Catheter Cardiovasc Interv 2015; 87:253-61. [DOI: 10.1002/ccd.25334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/15/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Jorge Belardi
- Department of Cardiology; Instituto Cardiovascular de Buenos Aires; Buenos Aires Argentina
| | - Ganesh Manoharan
- Cardiology Department; Royal Victoria Hospital; Belfast Northern Ireland United Kingdom
| | - Mariano Albertal
- Department of Cardiac Surgery and Department of Images; Instituto Cardiovascular de Buenos Aires; Buenos Aires Argentina
| | - Petr Widimský
- Cardiology Department, the Third Faculty of Medicine, Charles University & University Hospital Royal Vineyards; Prague Czech Republic
| | | | - Sigmund Silber
- Department of Cardiology; Heart Centre at the Isar; Munich Germany
| | - Martin B. Leon
- Department of Medicine; Division of Cardiology; Columbia University Medical Center and NewYork-Presbyterian Hospital; New York New York
| | - Shigeru Saito
- Department of Cardiology & Catheterization Laboratories; Shonan Kamakura General Hospital; Kamakura City Japan
| |
Collapse
|
39
|
|
40
|
Valle JA, Messenger JC. Triple Therapy…Can We Replace More With Better?∗. J Am Coll Cardiol 2015; 66:628-30. [DOI: 10.1016/j.jacc.2015.04.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 11/25/2022]
|
41
|
Bartorelli AL, Egidy Assenza G, Abizaid A, Banning A, Džavík V, Ellis S, Gao R, Holmes D, Ho Jeong M, Legrand V, Neumann FJ, Spaulding C, Worthley SG, Urban P. One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry. Catheter Cardiovasc Interv 2015; 87:52-62. [DOI: 10.1002/ccd.26026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 04/12/2015] [Accepted: 04/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network; Toronto Canada
| | | | - Runlin Gao
- Cardiovascular Institute and Fu Wai Hospital; Beijing China
| | | | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital; Gwang Ju Korea
| | | | | | - Christian Spaulding
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris; Paris Descartes University and INSERM; U 970 Paris France
| | - Stephen G. Worthley
- Cardiovascular Investigation Unit Royal Adelaide Hospital; Adelaide Australia
| | | | | |
Collapse
|
42
|
Garg P, Wijeysundera HC, Yun L, Cantor WJ, Ko DT. Practice patterns and trends in the use of medical therapy in patients undergoing percutaneous coronary intervention in Ontario. J Am Heart Assoc 2014; 3:jah3606. [PMID: 25122664 PMCID: PMC4310369 DOI: 10.1161/jaha.114.000882] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Clinical guidelines emphasize medical therapy as the initial approach to the management of patients with stable coronary artery disease (CAD). However, the extent to which medical therapy is applied before and after percutaneous coronary intervention (PCI) in contemporary clinical practice is uncertain. We evaluated medication use for patients with stable CAD undergoing PCI, and assessed whether the COURAGE study altered medication use in the Canadian healthcare system. METHODS AND RESULTS A population-based cohort of 23 680 older patients >65 years old) with stable CAD undergoing PCI in Ontario between 2003 and 2010 was assembled. Optimal medical therapy (OMT) was defined as prescription for a β-blocker, statin, and either angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in the 90 days before PCI, and the same medications plus thienopyridine 90 days following PCI. Prior to PCI, 8023 (33.9%) patients were receiving OMT, 11 891 (50.2%) were on suboptimal therapy, and 3766 (15.9%) were not prescribed any medications of interest. There was significant improvement in medical therapy following PCI (OMT: 11 149 [47.1%], suboptimal therapy: 11 591 [48.9%], and none: 940 [4.0%], P<0.001). Utilization rate of OMT reduced significantly after the publication of COURAGE (34.9% before versus 32.8% after, P<0.001). Similarly, the rate of OMT following PCI was lower in the period after publication of COURAGE (47.3% before versus 46.9% after, P<0.001). CONCLUSIONS OMT was prescribed in about 1 in 3 patients prior to PCI and less than half after PCI. In contrast to the anticipated impact of COURAGE, we found lower rates of medication use in PCI patients after its publication.
Collapse
Affiliation(s)
- Pallav Garg
- Department of Medicine, London Health Sciences Center, Western University, London, ON, Canada (P.G.)
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (H.C.W., L.Y., D.T.K.) Sunnybrook Health Sciences Center, Toronto, ON, Canada (H.C.W., D.T.K.) Department of Medicine, University of Toronto, Toronto, ON, Canada (H.C.W., W.J.C., D.T.K.)
| | - Lingsong Yun
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (H.C.W., L.Y., D.T.K.)
| | - Warren J Cantor
- Southlake Regional Health Center, Newmarket, ON, Canada (W.J.C.) Department of Medicine, University of Toronto, Toronto, ON, Canada (H.C.W., W.J.C., D.T.K.)
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (H.C.W., L.Y., D.T.K.) Sunnybrook Health Sciences Center, Toronto, ON, Canada (H.C.W., D.T.K.) Department of Medicine, University of Toronto, Toronto, ON, Canada (H.C.W., W.J.C., D.T.K.)
| |
Collapse
|
43
|
SAT-TAVI (single antiplatelet therapy for TAVI) study: A pilot randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation. Int J Cardiol 2014; 174:624-7. [DOI: 10.1016/j.ijcard.2014.04.170] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/19/2014] [Accepted: 04/14/2014] [Indexed: 01/21/2023]
|
44
|
Cuschieri JR, Drawz P, Falck-Ytter Y, Wong RCK. Risk factors for acute gastrointestinal bleeding following myocardial infarction in veteran patients who are prescribed clopidogrel. J Dig Dis 2014; 15:195-201. [PMID: 24373542 DOI: 10.1111/1751-2980.12123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our aim was to identify risk factors for acute gastrointestinal (GI) bleeding in patients with myocardial infarction (MI) who were prescribed clopidogrel following hospital discharge. METHODS Data were collected retrospectively from patients treated in Veteran Affairs hospitals in Ohio, USA, from 2001 to 2008 with a primary diagnosis of MI (International Classification of Diseases, 9th Revision) and a prescription for clopidogrel filled within 48 h of discharge. Primary outcome was acute GI bleeding after discharge. RESULTS Acute GI bleeding occurred in 107 of 3218 patients. Bleeding occurred in those who were elder (66.2 vs. 62.4 years, P = 0.0002), had lower glomerular filtration rate (74 vs. 81 mL/min, P = 0.024), had filled prescription for warfarin (15.9% vs. 6.9%, P = 0.0004), diagnosed as atrial fibrillation (20.6% vs. 11.1%, P = 0.003), chronic liver (5.6% vs. 2.2%, P = 0.018) or kidney disease (29.0% vs. 19.4%, P = 0.016). A risk model and GI bleed risk score were developed and showed that patients with age >65 years, use of warfarin, the presence of chronic liver or kidney disease were at increased risk for GI bleeding. CONCLUSIONS Veterans patients of advanced age, using warfarin and with chronic liver and kidney disease may be at increased risk of GI bleeding when prescribed clopidogrel following MI. A scoring system may help to identify patients at high risk for GI bleeding.
Collapse
|
45
|
Shuvy M, Ko DT. Bleeding after percutaneous coronary intervention: can we still ignore the obvious? Open Heart 2014; 1:e000036. [PMID: 25332793 PMCID: PMC4195920 DOI: 10.1136/openhrt-2014-000036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 01/24/2023] Open
Affiliation(s)
- Mony Shuvy
- Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada
| | - Dennis T Ko
- Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario , Canada ; Department of Medicine , University of Toronto , Toronto, Ontario , Canada ; Institute for Clinical Evaluative Sciences , Toronto, Ontario , Canada
| |
Collapse
|
46
|
Rationale and design of the LEADERS FREE trial: A randomized double-blind comparison of the BioFreedom drug-coated stent vs the Gazelle bare metal stent in patients at high bleeding risk using a short (1 month) course of dual antiplatelet therapy. Am Heart J 2013; 165:704-9. [PMID: 23622906 DOI: 10.1016/j.ahj.2013.01.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/03/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND RATIONALE Major bleeding is a powerful predictor of morbidity and mortality after percutaneous coronary intervention (PCI). To avoid prolonged dual antiplatelet therapy (DAPT), current guidelines recommend using a bare metal stent when PCI is indicated to treat patients at high risk of bleeding. The Biolimus A9-coated BioFreedom is a new stainless steel drug-coated stent devoid of polymer and has been shown to be associated with a low median late-loss of 0.17 mm at 12 months of follow-up. In an animal model, 98% of the drug has diffused into the vessel wall at 1 month. It is therefore reasonable to consider that such a device may have a potential safety advantage, and a lesser dependence on prolonged DAPT than a polymer-coated drug-eluting stent. TRIAL DESIGN A total of 2456 patients considered at high risk of bleeding will be randomized in a double-blind fashion to the BioFreedom drug-coated stent or to a control arm (Gazelle bare metal stent). Both groups will be treated with DAPT during 1 month only, followed by long-term aspirin alone. At 1-year follow-up, the primary safety endpoint (a composite of cardiac death, myocardial infarction and stent thrombosis) will be assessed by a non-inferiority analysis, and the primary efficacy endpoint (clinically driven target lesion revascularization) by a superiority analysis. CONCLUSIONS This trial should help better characterize a neglected subset of PCI patients and quantify both their thrombotic and bleeding risks. It has the potential to decrease the need for target lesion revascularization in patients unable to tolerate a prolonged course of DAPT and will assess the shortest DAPT course ever used with an active stent.
Collapse
|
47
|
Nadatani Y, Watanabe T, Tanigawa T, Sogawa M, Yamagami H, Shiba M, Watanabe K, Tominaga K, Fujiwara Y, Yoshiyama M, Arakawa T. Incidence and risk factors of gastrointestinal bleeding in patients on low-dose aspirin therapy after percutaneous coronary intervention in Japan. Scand J Gastroenterol 2013; 48:320-5. [PMID: 23298342 DOI: 10.3109/00365521.2012.758771] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low-dose aspirin (LDA) is the most commonly prescribed antiplatelet agent for prevention of cardiovascular events following percutaneous coronary intervention (PCI). Long-term treatment with LDA has serious adverse effects, including gastrointestinal (GI) hemorrhage. Most studies have focused only on upper GI bleeding and few studies have evaluated the effect of LDA on total GI bleeding. AIMS The aims of this study were to investigate the incidence and risk factors of total GI bleeding within 30 days after PCI in Japanese patients taking LDA. METHODS A retrospective chart review was conducted for 364 patients undergoing LDA therapy following PCI at Osaka City University Hospital. A retrospective case-control study evaluated risk factors using the chi-squared test and logistic regression. RESULTS The incidence of total GI bleeding after PCI within 30 days was 4.3%. The source of the GI bleeding was located throughout the GI tract. Risk factors identified by univariate analysis were age ≥ 75 years, history of peptic ulcer disease, chronic renal failure, proton pump inhibitor use, and histamine H2 receptor antagonist use. By multivariate logistic regression only age ≥ 75 years (odds ratio = 5.26; 95% confidence interval: 1.13-24.51; p = 0.035) was found to be an independent risk factor of GI bleeding. CONCLUSIONS The incidence of GI bleeding in patients undergoing LDA therapy following PCI is high. The bleeding episodes were located in the upper, middle, and lower GI tract. Age of ≥ 75 years was an independent risk factor for GI bleeding after PCI in patients on LDA therapy.
Collapse
Affiliation(s)
- Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Rossini R, Baroni M, Musumeci G, Gavazzi A. Oral antiplatelet therapy after drug-eluting stent implantation. J Cardiovasc Med (Hagerstown) 2013; 14:81-90. [DOI: 10.2459/jcm.0b013e328356a545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
49
|
Preoperative identification of patients with increased risk for perioperative bleeding. Curr Opin Anaesthesiol 2013; 26:82-90. [DOI: 10.1097/aco.0b013e32835b9a23] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
50
|
Use of thrombolysis in myocardial infarction risk score to predict bleeding complications in patients with unstable angina and non-ST elevation myocardial infarction undergoing percutaneous coronary intervention. Cardiovasc Interv Ther 2013; 28:242-9. [PMID: 23361950 DOI: 10.1007/s12928-013-0162-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
Thrombolysis in myocardial infarction (TIMI) is a prognostic score developed for managing the high risk of cardiac events immediately after unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI). In Asian populations that have a higher rate of bleeding complications, data about TIMI score are lacking. Using a Japanese multicenter registry, we investigated the impact of utilizing TIMI score in UA/NSTEMI patients, focusing on bleeding complications. The TIMI score was calculated for 587 patients who underwent percutaneous coronary intervention (PCI) for UA/NSTEMI (2008-2010). They were classified into low-risk (TIMI score 0-2, N = 268, 45.6 %), intermediate-risk (TIMI score 3-4, N = 264, 45.0 %) and high-risk (TIMI score 5-7, N = 55, 9.4 %) groups; patient characteristics for each group were statistically analyzed. The patients in the higher TIMI score group were older (p < 0.001), had lower GFR (p = 0.021) and hemoglobin level after PCI (p < 0.001), and severe coronary disease pattern (p = 0.014 and p = 0.023, respectively, for left main and three-vessel disease). The TIMI score was significantly associated with requirement of blood transfusion (low-risk, moderate-risk, and high-risk groups: 1.1, 4.2, and 7.3 %, respectively; p = 0.021), and the incidence of access site bleeding (1.1, 2.7, and 5.5 %, p = 0.112). The TIMI score might aid in subjectively quantifying the risk of in-hospital complication rates such as access site bleeding.
Collapse
|