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ABS20191028_0004
| Bifurcation/Left Main Diseases and Intervention | |
| Percutaneous Coronary Intervention Complexity and Risk of Adverse Events in Relation to High Bleeding Risk Among Patients Receiving Drug-Eluting Stents: A Large Single-Center Cohort Study | |
| Haoyu Wang1, Kefei Dou2 | |
| Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China1, Fuwai Hospital, China2 | |
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Background:
The impact of high bleeding risk (HBR) estimated by PARIS bleeding risk score on the occurrence of ischemic and bleeding events after complex percutaneous coronary intervention (PCI) is unknown, we sought to report clinical outcomes after complex PCI procedures and their association with HBR.
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Methods:
Between January 2013 and December 2013, a total of 10,167 consecutive patients undergoing PCI were prospectively enrolled in Fuwai PCI Registry. Complex PCI was defined as having at least one of the following features: 3 vessels treated, ¡Ã3 stents implanted, ¡Ã3 lesions treated, bifurcation PCI with¡Ã2 stents, total stent length >60mm, chronic total occlusion, unprotected left main, restenosis or severely calcified lesion. The primary ischemic endpoint was major adverse cardiovascular events (MACE) [composite of cardiac death, myocardial infarction, and definite/probable stent thrombosis], and the primary bleeding endpoint was BARC type 2, 3, or 5 bleeding.
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Results:
During a median follow-up of 29 months, patients who underwent complex PCI procedures experienced higher risks of MACE (hazard ratio [HR]: 1.58, 95% confidence interval [CI]: 1.16-2.15; P=0.004) and target lesion failure (HR: 1.60, 95% CI: 1.33-1.92) in adjusted Cox regression analysis, compared to those having non-complex PCI. In contrast, the risk of BARC major bleeding was statistically similar between the 2 groups (HR: 0.82, 95% CI: 0.64-1.06; P=0.128). There was no statistical interaction between HBR (PARIS bleeding score ¡Ã8 or <8) and complex PCI in regard to MACE (adjusted P interaction=0.630) and major bleeding (adjusted P interaction=0.269).
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Conclusion:
Patients who had undergone complex PCI resulted in substantially more ischemic events, without an increase in clinically relevant bleeding risk; and theses associations did not seem to be modified by HBR status. More intensified antiplatelet therapy may be beneficial for patients undergoing complex PCI.
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