Coronary Thrombosis and Major Bleeding after PCI with Drug-Eluting Stents Risk Scores from Paris

Usman Baber, Roxana Mehran, Gennaro Giustino, David J. Cohen, Timothy D. Henry, Samantha Sartori, Cono Ariti, Claire Litherland, George Dangas, C. Michael Gibson, Mitchell W. Krucoff, David J. Moliterno, Ajay J. Kirtane, Gregg W. Stone, Antonio Colombo, Alaide Chieffo, Annapoorna S. Kini, Bernhard Witzenbichler, Giora Weisz, Philippe Gabriel StegStuart Pocock

Research output: Contribution to journalArticle

Abstract

Background Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking. Objectives The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after percutaneous coronary intervention with drug-eluting stents. Methods Using data from 4,190 patients treated with drug-eluting stents and enrolled in the Paris (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) registry, separate risk scores were developed to predict CTE (defined as the composite of stent thrombosis or myocardial infarction) and MB (defined as the occurrence of a Bleeding Academic Research Consortium type 3 or 5 bleed). External validation was performed in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) registry. Results Over 2 years, CTEs occurred in 151 patients (3.8%) and MB in 133 (3.3%). Independent predictors of CTEs included acute coronary syndrome, prior revascularization, diabetes mellitus, renal dysfunction, and current smoking. Independent predictors of MB included older age, body mass index, triple therapy at discharge, anemia, current smoking, and renal dysfunction. Each model displayed moderate levels of discrimination and adequate calibration. Conclusions Simple risk scores of baseline clinical variables may be useful to predict risks for ischemic and bleeding events after PCI with DES, thereby facilitating clinical decisions surrounding the optimal duration of DAPT. (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients [Paris]; NCT00998127)
Original languageEnglish
Pages (from-to)2224 - 2234
Number of pages11
JournalJournal of the American College of Cardiology
Volume67
Issue number19
DOIs
Publication statusPublished - May 17 2016

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Keywords

  • bleeding
  • PCI
  • risk
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Baber, U., Mehran, R., Giustino, G., Cohen, D. J., Henry, T. D., Sartori, S., Ariti, C., Litherland, C., Dangas, G., Michael Gibson, C., Krucoff, M. W., Moliterno, D. J., Kirtane, A. J., Stone, G. W., Colombo, A., Chieffo, A., Kini, A. S., Witzenbichler, B., Weisz, G., ... Pocock, S. (2016). Coronary Thrombosis and Major Bleeding after PCI with Drug-Eluting Stents Risk Scores from Paris. Journal of the American College of Cardiology, 67(19), 2224 - 2234. https://doi.org/10.1016/j.jacc.2016.02.064