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Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1194-1204. doi: 10.1002/ccd.28325. Epub 2019 May 21.

A risk score to predict postdischarge bleeding among acute coronary syndrome patients undergoing percutaneous coronary intervention: BRIC-ACS study.

Author information

1
Department of Cardiology, General Hospital of Chinese People's Liberation Army, Beijing, China.
2
Department of Cardiology, Peking Union Medical College Hospital, Beijing, China.
3
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
4
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
5
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
6
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
7
Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
8
Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
9
Heart Canter, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
10
Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
11
Department of Cardiology, Zhengzhou University People's Hospital (Henan Provincial People's Hospital), Zhengzhou, China.
12
Department of Cardiology, The First Hospital of Jilin University, Changchun, China.
13
Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai, China.
14
Department of Cardiology, Second Affiliated Hospital, Nanchang University, Nanchang, China.
15
Department of Cardiology, The People's Hospital of Liaoning Province, Shenyang, China.
16
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
17
Cardiovascular Center, Capital Medical University, Beijing Friendship Hospital, Beijing, China.
18
Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, China.
19
Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
20
Department of Cardiology, Daqing Oilfield General Hospital, Daqing, China.
21
Department of Cardiology, Jilin Province People's Hospital, Changchun, China.
22
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
23
Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China.
24
Department of Cardiology, General Hospital of Guang Zhou Military Command, Guangzhou, China.
25
Department of Cardiology, Hunan Provincial People's Hospital, Changsha, China.
26
Department of Cardiology, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
27
Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
28
Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
29
Department of Cardiology, Fuxing Hospital Affiliated to Capital Medical University, Beijing, China.
30
Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China.

Abstract

BACKGROUND:

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) prevents ischemic events while increasing bleeding risk. Real-world-based metrics to accurately predict postdischarge bleeding (PDB) occurrence and its potential impact on postdischarge major cardiovascular event (MACE) remain undefined. This study sought to evaluate the impact of PDB on MACE occurrence, and to develop a score to predict PDB risk among Chinese acute coronary syndrome (ACS) patients after PCI.

METHODS AND RESULTS:

From May 2014 to January 2016, 2496 ACS patients who underwent PCI were recruited consecutively from 29 nationally representative Chinese tertiary hospitals. Among 2,381 patients (95.4%, 2,381/2,496) who completed 1-year follow-up, the cumulative incidence of PDB (bleeding academic research consortium type [BARC] ≥2) and postdischarge MACE (a composite of all-cause death, nonfatal myocardial infarction, ischemic stroke, or urgent revascularization) was 4.9% (n = 117) and 3.3% (n = 79), respectively. The association between PDB and MACE during 1-year follow-up, as well as the impact of DAPT with ticagrelor or clopidogrel on PDB were evaluated. PDB was associated with higher risk of postdischarge MACE (7.7 vs. 3.1%; adjusted hazard ratio: 2.59 [95% confidence interval: 1.17-5.74]; p = .02). For ticagrelor versus clopidogrel, PDB risk was higher (8.0 vs. 4.4%; 2.05 [1.17-3.60]; p = .01), while MACE risk was similar (2.0 vs. 3.4%; 0.70 [0.25-1.93]; p = .49). Based on identified PDB predictors, the constructed bleeding risk in real world Chinese acute coronary syndrome patients (BRIC-ACS) score for PDB was established. C-statistic for the score for PDB was 0.67 (95% CI: 0.62-0.73) in the overall cohort, and >0.70 in subgroups with non-ST- and ST-segment elevation myocardial infarction, diabetes and receiving more than two drug eluting stents.

CONCLUSIONS:

In Chinese ACS patients, PDB with BARC ≥2 was associated with higher risk for MACE after PCI. The constructed BRIC-ACS risk score provides a useful tool for PDB discrimination, particularly among high ischemic and bleeding risk patients.

KEYWORDS:

antiplatelet therapy; bleeding; coronary artery disease; percutaneous coronary intervention

PMID:
31112635
DOI:
10.1002/ccd.28325

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