Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention

Philippe Genereux, Gennaro Giustino, Bernhard Witzenbichler, Giora Weisz, Thomas D. Stuckey, Michael J. Rinaldi, Franz Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest Mazzaferri, Mayank Yadav, Dominic P. Francese, Tullio Palmerini, Ajay J. Kirtane, Claire Litherland, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Background The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. Objectives This study sought to characterize the determinants and consequences of PDB after PCI. Methods The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. Results Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009). Conclusions After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).

Original languageEnglish (US)
Article number21540
Pages (from-to)1036-1045
Number of pages10
JournalJournal of the American College of Cardiology
Volume66
Issue number9
DOIs
StatePublished - Sep 1 2015

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Percutaneous Coronary Intervention
Drug-Eluting Stents
Hemorrhage
Incidence
Mortality
clopidogrel
Myocardial Infarction
Therapeutics
Survivors
Hemoglobins
Blood Platelets

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, P., Giustino, G., Witzenbichler, B., Weisz, G., Stuckey, T. D., Rinaldi, M. J., ... Stone, G. W. (2015). Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 66(9), 1036-1045. [21540]. https://doi.org/10.1016/j.jacc.2015.06.1323
Genereux, Philippe ; Giustino, Gennaro ; Witzenbichler, Bernhard ; Weisz, Giora ; Stuckey, Thomas D. ; Rinaldi, Michael J. ; Neumann, Franz Josef ; Metzger, D. Christopher ; Henry, Timothy D. ; Cox, David A. ; Duffy, Peter L. ; Mazzaferri, Ernest ; Yadav, Mayank ; Francese, Dominic P. ; Palmerini, Tullio ; Kirtane, Ajay J. ; Litherland, Claire ; Mehran, Roxana ; Stone, Gregg W. / Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 9. pp. 1036-1045.
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abstract = "Background The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. Objectives This study sought to characterize the determinants and consequences of PDB after PCI. Methods The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. Results Among 8,582 {"}all-comers{"} who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2{\%}) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7{\%}) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0{\%} vs. 3.2{\%}; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009). Conclusions After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).",
author = "Philippe Genereux and Gennaro Giustino and Bernhard Witzenbichler and Giora Weisz and Stuckey, {Thomas D.} and Rinaldi, {Michael J.} and Neumann, {Franz Josef} and Metzger, {D. Christopher} and Henry, {Timothy D.} and Cox, {David A.} and Duffy, {Peter L.} and Ernest Mazzaferri and Mayank Yadav and Francese, {Dominic P.} and Tullio Palmerini and Kirtane, {Ajay J.} and Claire Litherland and Roxana Mehran and Stone, {Gregg W.}",
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Genereux, P, Giustino, G, Witzenbichler, B, Weisz, G, Stuckey, TD, Rinaldi, MJ, Neumann, FJ, Metzger, DC, Henry, TD, Cox, DA, Duffy, PL, Mazzaferri, E, Yadav, M, Francese, DP, Palmerini, T, Kirtane, AJ, Litherland, C, Mehran, R & Stone, GW 2015, 'Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention', Journal of the American College of Cardiology, vol. 66, no. 9, 21540, pp. 1036-1045. https://doi.org/10.1016/j.jacc.2015.06.1323

Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention. / Genereux, Philippe; Giustino, Gennaro; Witzenbichler, Bernhard; Weisz, Giora; Stuckey, Thomas D.; Rinaldi, Michael J.; Neumann, Franz Josef; Metzger, D. Christopher; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Mazzaferri, Ernest; Yadav, Mayank; Francese, Dominic P.; Palmerini, Tullio; Kirtane, Ajay J.; Litherland, Claire; Mehran, Roxana; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 66, No. 9, 21540, 01.09.2015, p. 1036-1045.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention

AU - Genereux, Philippe

AU - Giustino, Gennaro

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Rinaldi, Michael J.

AU - Neumann, Franz Josef

AU - Metzger, D. Christopher

AU - Henry, Timothy D.

AU - Cox, David A.

AU - Duffy, Peter L.

AU - Mazzaferri, Ernest

AU - Yadav, Mayank

AU - Francese, Dominic P.

AU - Palmerini, Tullio

AU - Kirtane, Ajay J.

AU - Litherland, Claire

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. Objectives This study sought to characterize the determinants and consequences of PDB after PCI. Methods The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. Results Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009). Conclusions After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).

AB - Background The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear. Objectives This study sought to characterize the determinants and consequences of PDB after PCI. Methods The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression. Results Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009). Conclusions After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).

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U2 - 10.1016/j.jacc.2015.06.1323

DO - 10.1016/j.jacc.2015.06.1323

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EP - 1045

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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