The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention

From the ACUITY trial

Mahesh V. Madhavan, Philippe Genereux, Tullio Palmerini, Adriano Caixeta, Ke Xu, Thomas C. McAndrew, Dominic P. Francese, Ajay J. Kirtane, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE: We sought to evaluate the relation between the extent of coronary artery disease (CAD) and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndrome (NSTEACS). BACKGROUND: Patients with severe CAD undergoing PCI for NSTEACS are at high risk for recurrent adverse events. Hemorrhagic events after PCI are associated with high rates of morbidity and mortality. Despite sharing many common risk factors, the relationship between the extent of CAD and bleeding after PCI remains understudied. METHODS: The SYNTAX score (SS) was used to quantify the extent and severity of CAD. We stratified 2627 patients from the ACUITY PCI cohort into SS groups based on score tertiles from the ACUITY trial (<7, 7-12, and >12). Thirty-day major bleeding rates were determined for each group. RESULTS: When stratified by ACUITY tertiles, 30-day major bleeding rates were significantly greater in the highest SS tertile (>12) than in the intermediate and lowest tertiles (P<.01). By multivariable analysis, the SS (by augmentation of 1 point) remained independently associated with 30-day major bleeding (hazard ratio ≤ 1.03; 95% confidence interval, 1.01-1.04; P<.01). CONCLUSION: The results of this large-scale study suggest that in addition to its previously described association with adverse ischemic events, the extent of CAD, as assessed by the SS, was independently associated with major bleeding after PCI for NSTEACS.

Original languageEnglish (US)
Pages (from-to)203-211
Number of pages9
JournalJournal of Invasive Cardiology
Volume27
Issue number4
StatePublished - Jan 1 2015
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Disease
Hemorrhage
Acute Coronary Syndrome
Confidence Intervals
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Madhavan, Mahesh V. ; Genereux, Philippe ; Palmerini, Tullio ; Caixeta, Adriano ; Xu, Ke ; McAndrew, Thomas C. ; Francese, Dominic P. ; Kirtane, Ajay J. ; Mehran, Roxana ; Stone, Gregg W. / The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention : From the ACUITY trial. In: Journal of Invasive Cardiology. 2015 ; Vol. 27, No. 4. pp. 203-211.
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abstract = "OBJECTIVE: We sought to evaluate the relation between the extent of coronary artery disease (CAD) and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndrome (NSTEACS). BACKGROUND: Patients with severe CAD undergoing PCI for NSTEACS are at high risk for recurrent adverse events. Hemorrhagic events after PCI are associated with high rates of morbidity and mortality. Despite sharing many common risk factors, the relationship between the extent of CAD and bleeding after PCI remains understudied. METHODS: The SYNTAX score (SS) was used to quantify the extent and severity of CAD. We stratified 2627 patients from the ACUITY PCI cohort into SS groups based on score tertiles from the ACUITY trial (<7, 7-12, and >12). Thirty-day major bleeding rates were determined for each group. RESULTS: When stratified by ACUITY tertiles, 30-day major bleeding rates were significantly greater in the highest SS tertile (>12) than in the intermediate and lowest tertiles (P<.01). By multivariable analysis, the SS (by augmentation of 1 point) remained independently associated with 30-day major bleeding (hazard ratio ≤ 1.03; 95{\%} confidence interval, 1.01-1.04; P<.01). CONCLUSION: The results of this large-scale study suggest that in addition to its previously described association with adverse ischemic events, the extent of CAD, as assessed by the SS, was independently associated with major bleeding after PCI for NSTEACS.",
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Madhavan, MV, Genereux, P, Palmerini, T, Caixeta, A, Xu, K, McAndrew, TC, Francese, DP, Kirtane, AJ, Mehran, R & Stone, GW 2015, 'The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention: From the ACUITY trial', Journal of Invasive Cardiology, vol. 27, no. 4, pp. 203-211.

The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention : From the ACUITY trial. / Madhavan, Mahesh V.; Genereux, Philippe; Palmerini, Tullio; Caixeta, Adriano; Xu, Ke; McAndrew, Thomas C.; Francese, Dominic P.; Kirtane, Ajay J.; Mehran, Roxana; Stone, Gregg W.

In: Journal of Invasive Cardiology, Vol. 27, No. 4, 01.01.2015, p. 203-211.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention

T2 - From the ACUITY trial

AU - Madhavan, Mahesh V.

AU - Genereux, Philippe

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Xu, Ke

AU - McAndrew, Thomas C.

AU - Francese, Dominic P.

AU - Kirtane, Ajay J.

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - OBJECTIVE: We sought to evaluate the relation between the extent of coronary artery disease (CAD) and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndrome (NSTEACS). BACKGROUND: Patients with severe CAD undergoing PCI for NSTEACS are at high risk for recurrent adverse events. Hemorrhagic events after PCI are associated with high rates of morbidity and mortality. Despite sharing many common risk factors, the relationship between the extent of CAD and bleeding after PCI remains understudied. METHODS: The SYNTAX score (SS) was used to quantify the extent and severity of CAD. We stratified 2627 patients from the ACUITY PCI cohort into SS groups based on score tertiles from the ACUITY trial (<7, 7-12, and >12). Thirty-day major bleeding rates were determined for each group. RESULTS: When stratified by ACUITY tertiles, 30-day major bleeding rates were significantly greater in the highest SS tertile (>12) than in the intermediate and lowest tertiles (P<.01). By multivariable analysis, the SS (by augmentation of 1 point) remained independently associated with 30-day major bleeding (hazard ratio ≤ 1.03; 95% confidence interval, 1.01-1.04; P<.01). CONCLUSION: The results of this large-scale study suggest that in addition to its previously described association with adverse ischemic events, the extent of CAD, as assessed by the SS, was independently associated with major bleeding after PCI for NSTEACS.

AB - OBJECTIVE: We sought to evaluate the relation between the extent of coronary artery disease (CAD) and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndrome (NSTEACS). BACKGROUND: Patients with severe CAD undergoing PCI for NSTEACS are at high risk for recurrent adverse events. Hemorrhagic events after PCI are associated with high rates of morbidity and mortality. Despite sharing many common risk factors, the relationship between the extent of CAD and bleeding after PCI remains understudied. METHODS: The SYNTAX score (SS) was used to quantify the extent and severity of CAD. We stratified 2627 patients from the ACUITY PCI cohort into SS groups based on score tertiles from the ACUITY trial (<7, 7-12, and >12). Thirty-day major bleeding rates were determined for each group. RESULTS: When stratified by ACUITY tertiles, 30-day major bleeding rates were significantly greater in the highest SS tertile (>12) than in the intermediate and lowest tertiles (P<.01). By multivariable analysis, the SS (by augmentation of 1 point) remained independently associated with 30-day major bleeding (hazard ratio ≤ 1.03; 95% confidence interval, 1.01-1.04; P<.01). CONCLUSION: The results of this large-scale study suggest that in addition to its previously described association with adverse ischemic events, the extent of CAD, as assessed by the SS, was independently associated with major bleeding after PCI for NSTEACS.

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