Impact of in-hospital bleeding according to the bleeding academic research consortium classification on the long-term adverse outcomes in patients undergoing percutaneous coronary intervention

2014 ◽  
Vol 85 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Yong-Hoon Yoon ◽  
Young-Hak Kim ◽  
Seon-Ok Kim ◽  
Jong-Young Lee ◽  
Duk-Woo Park ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Academic Research ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Percutaneous Coronary ◽  
Research Consortium

Gamma-Glutamyl Transferase-to-Platelet Ratio as a Novel Predictor of Long-Term Adverse Outcomes in Patients after Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

2019 ◽  
Vol 119 (06) ◽  
pp. 1021-1030 ◽  
Author(s):  
Ying-Ying Zheng ◽  
Ting-Ting Wu ◽  
You Chen ◽  
Xian-Geng Hou ◽  
Yi Yang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Gamma Glutamyl Transferase ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Glutamyl Transferase

Background Gamma-glutamyl transferase (GGT) has been shown to be involved in the pathogenesis of both coronary artery disease (CAD) and liver disease, and it has been reported that the GGT-to-platelet ratio (GPR) is an independent predictor for adverse outcomes from liver fibrosis and hepatic carcinoma. However, the relation between the GPR and adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) has not been investigated. Methods A total of 5,636 patients enrolled in Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI, a retrospective cohort study, from January 2008 to December 2016, were divided into two groups according to GPR (GPR < 0.12, n = 2,769 and GPR ≥ 0.12, n = 2,867). The primary outcome was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM) after PCI. The average follow-up time was 35.9 ± 22.6 months. Results We found that there were significant differences between the two groups in the incidences of ACM (p = 0.011), CM (p = 0.001), major adverse cardiovascular events (MACEs, p < 0.024), major adverse cardiovascular and cerebrovascular events (MACCEs, p = 0.014) and bleeding events (p = 0.003). Multivariate Cox regression analyses showed that GPR was an independent predictor for ACM (hazard ratio [HR]: 1.536 [95% confidence interval [CI]:1.162–2.032], p = 0.003), CM (HR: 1.763 [95% CI: 1.283–2.424], p < 0.001), MACCEs (HR: 1.269 [95% CI: 1.066–1.511], p = 0.007) and MACEs (HR: 1.308 [95% CI: 1.089–1.570], p = 0.004) in stable CAD patients but that it was an independent predictor for only the incidence of bleeding events (HR: 3.104 [95% CI: 1.680–5.736], p < 0.001) in acute coronary syndrome (ACS) patients. Conclusion This study indicates that GPR is an independent and novel predictor of adverse long-term outcomes in CAD patients who underwent PCI.

Early stent thrombosis with bivalirudin in patients undergoing percutaneous coronary intervention

2015 ◽  
Vol 113 (05) ◽  
pp. 1010-1020 ◽  
Author(s):  
Raffaele Piccolo ◽  
Chiara De Biase ◽  
Carolina D’Anna ◽  
Bruno Trimarco ◽  
Federico Piscione ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Academic Research ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Research Consortium

SummaryAlthough bivalirudin has been shown to reduce bleeding events in patients undergoing percutaneous coronary intervention, residual concerns remain about a possible higher risk of early (within 30 days) stent thrombosis (ST). Therefore, we performed a meta-analysis of randomised trials reporting ST events with bivalirudin compared to other antithrombotic therapies (heparins ± glycoprotein IIb/IIIa inhibitors). A systematic literature search of electronic resources was performed through May, 2014. The primary endpoint was definite early ST, according to Academic Research Consortium criteria. Secondary endpoints included: all-cause death, myocardial infarction and major bleeding. A total of 11 trials, including 16,415 patients, were accrued. Compared to other regimens, bivalirudin significantly increased the risk of early ST (odds ratio [OR]=1.80; 95 % confidence interval [CI], 1.28 2.52; p=0.0007) and reduced the risk of major bleeding (OR [95 %CI]=0.64 [0.51 0.82], p=0.0003), with a comparable risk of mortality or myocardial infarction. The higher risk of early ST was mainly attributable to acute (OR [95 % CI] =4.33 [2.33 8.05], p < 0.001) than subacute (OR [95 % CI] =0.89 [0.53 1.50], p =0.67) ST events (p for interaction < 0.001). Non-fatal myocardial infarction was the most common presentation (83 %) of early ST events, while death occurred infrequently (about 5 %). In conclusion, in patients undergoing PCI, bivalirudin compared to heparins is associated with a higher risk of early ST, which is mainly related to more frequent acute events. Further studies are required to evaluate alternative strategies to mitigate this risk, without hampering the benefits derived from the reduction in bleeding events with bivalirudin.

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

2020 ◽  
Vol 9 (5) ◽  
pp. 488-495 ◽  
Author(s):  
Kensaku Nishihira ◽  
Nozomi Watanabe ◽  
Nehiro Kuriyama ◽  
Yoshisato Shibata
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Academic Research ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Research Consortium ◽  
Therapeutic Decision Making

Background With increases in life expectancy, percutaneous coronary intervention is being performed more often, even in elderly patients with acute myocardial infarction. However, the optimal management of nonagenarians with acute myocardial infarction is uncertain. This study sought to investigate clinical outcomes of nonagenarians who undergo percutaneous coronary intervention. Methods Of 2640 consecutive patients with acute myocardial infarction hospitalised within 24 hours after symptom onset in 2009–2018, we prospectively analysed 96 nonagenarians (median age 92 years; interquartile range 91–94) who underwent percutaneous coronary intervention. Results The median follow-up period was 375 days. Inhospital major bleeding (Bleeding Academic Research Consortium type 3 or 5) and inhospital death occurred in 15.6% and 17.7% of patients, respectively. The proportion of patients with frailty increased during hospitalisation, from 43.8% (mild frailty 37.5%; moderate to severe frailty 6.3%) at admission to 60.7% (mild frailty 46.8%; moderate to severe frailty 13.9%) at discharge ( P < 0.01). The cumulative incidence of all-cause mortality was 22.2% at 180 days and 27.5% at 365 days. After adjusting for confounders, cardiogenic shock (hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.07–7.64) and final thrombolysis in myocardial infarction flow grade less than 3 (HR 2.45; 95% CI 1.03–5.58) were associated with higher mid-term mortality and cardiac rehabilitation (HR 0.25; 95% CI, 0.13–0.50) was associated with lower mid-term mortality. Conclusions The mid-term mortality of selected nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention is reasonable, but older patients have high rates of inhospital major bleeding and progression of frailty. This study provides physicians, patients and families with important information for therapeutic decision-making.

Abstract 12614: Total Thrombus Formation Analysis System Can Predict High Bleeding Risk in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobuhiro Nakanishi ◽  
Koichi Kaikita ◽  
Kenichi Tsujita
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Thrombus Formation ◽  
Academic Research ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Analysis System ◽  
Research Consortium ◽  
High Bleeding Risk

Introduction: Antithrombotic therapy is established for the treatment in various cardiovascular events, however, it has shown to increase the bleeding risk. Total Thrombus-formation Analysis System (T-TAS) is reported to be useful for evaluating thrombogenicity. Hypothesis: We examined whether T-TAS might predict 1-year bleeding risk in patients undergoing percutaneous coronary intervention (PCI). Methods: This was a retrospective, observational study at Kumamoto University Hospital between April 2017 and March 2019. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR10-AUC30, AUC for AR chip). We divided the study population into 2 groups according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) (182 patients in ARC-HBR positive, 118 in ARC-HBR negative). The primary endpoint was 1-year bleeding events that were defined by Bleeding Academic Research Consortium type2, 3, or 5. Results: The AR10-AUC30 levels were significantly lower in the ARC-HBR positive group than in the ARC-HBR negative group (median [interquartile range] 1568.1 [1258.5-1744.1] vs. 1723.1 [1567.0-1799.5], p<0.001). The combination of ARC-HBR and AR10-AUC30 could discriminate the bleeding risk, and improved predictive capacity compared with ARC-HBR by c-statistics and integrated discrimination improvement. In multivariate Cox hazards analyses, combining ARC-HBR and lower AR10-AUC30 levels were significantly associated with 1-year bleeding events. Decision curve analysis revealed that combining AR10-AUC30 with ARC-HBR ameliorated risk-prediction of bleeding events. Conclusions: The results highlighted that AR10-AUC30 could be a potentially useful marker for predicting high bleeding risk in patients undergoing PCI.

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