Transradial Percutaneous Coronary Intervention for Major Reduction of Bleeding Complications

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

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Abstract 317: Costs and Benefits Associated with Transradial Percutaneous Coronary Intervention in China

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.317 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Chen Jin ◽

Xin-ran Tang ◽

Qiu-ting Dong ◽

Wei Li ◽

Wei Zhao ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Length Of Stay ◽

Cost Saving ◽

Coronary Intervention ◽

Observational Research ◽

Bleeding Complications ◽

Costs And Benefits ◽

Hospital Outcomes ◽

Percutaneous Coronary

Background: Transradial percutaneous coronary intervention (TRI) has been increasingly used in the treatment of ischemic heart disease. While there are few studies examining the costs and benefits of transradial vs. transfemoral (TFI) in experienced centers among highly selected patients, treatment patterns and cost data obtained from the United States and European countries might not be generalizable to the developing world. Methods: We performed a retrospective analysis of patients undergoing PCI in the largest heart center in China between January and December 2010. Propensity score inverse probability weighting (IPW) method was used to compare costs and in-hospital outcomes between TRI and TFI, while controlling for potential treatment selection inherent in observational research. Results: Of 5,307patients undergoing PCI, 4,684 (88.3%) received TRI. Those undergoing TRI were younger, were less likely to be female, less likely to have prior myocardial infarction, PCI, or CABG, and more often presented with STEMI. After IPW adjustment, TRI was associated with fewer bleeding complications (BARC≥3 0.7% vs. 2.2%, OR 0.36, 95% CI 0.18-0.68), major adverse cardiovascular event (a composite of death, myocardial infarction, BARC bleeding≥3 or unplanned revascularization; 1.8% vs. 4.0%, OR 0.49, 95% CI 0.31-0.79), and shorter length of stay (6.1 vs 8.3 days, adjusted difference -1.5 days, 95% CI -1.9 to -1.2; Table ). TRI was associated with a cost saving of $1,261 (95% CI $967-$1,557) as compared with TFI. The cost saving was mainly driven by reduced procedural-related cost ($761) from differential use of vascular closure device and lower hospitalization cost ($217) related to shorter length of stay. Similar results were found in clinically relevant groups of myocardial infarction (STEMI and NSTEMI), acute coronary syndrome (STEMI, NSTEMI, and unstable angina), and stable angina. Conclusions: Compared with the TFI approach, TRI was associated with fewer complications, shorter length of stay, lower costs, and improved in-hospital outcomes.

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Abstract 291: Platelet Function Monitoring After Percutaneous Coronary Intervention: Updated Meta-analysis of Randomized Trials.

Circulation Research ◽

10.1161/res.121.suppl_1.291 ◽

2017 ◽

Vol 121 (suppl_1) ◽

Author(s):

Akintunde M Akinjero ◽

Oluwole Adegbala ◽

Esosa Edo-Osagie ◽

Nike Akinjero ◽

Tomi Akinyemiju

Keyword(s):

Percutaneous Coronary Intervention ◽

Platelet Function ◽

Meta Analysis ◽

Coronary Intervention ◽

Cardiovascular Death ◽

Bleeding Complications ◽

Major Adverse Cardiovascular Events ◽

Future Research ◽

Funnel Plot ◽

Percutaneous Coronary

Background: The need to balance bleeding and clotting risks after percutaneous coronary intervention (PCI) has led to interest in platelet function monitoring as a strategy to improve post-PCI outcomes. The prognostic value of platelet function testing in monitoring response to antiplatelet therapy after PCI remains unclear. Prior studies have been inconclusive. We sought to conduct an updated meta-analysis to address this gap in knowledge. Methods: We conducted a systematic search of EMBASE, PUBMED and the Cochrane libraries for studies since inception to December 2016 on platelet function monitoring. Our search yielded 203 studies, out of which 83 were extracted for full-text review. Only 3 studies met inclusion criteria. We pooled odds ratios using random-effects statistics, Mantel-Haenszel method. I2 and Chi- squared statistic was used to evaluate for heterogeneity. Publication bias was assessed using the funnel plot. Primary outcome was major adverse cardiovascular events (MACE). This was defined in the studies as a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and bleeding complications. Results: The 3 randomized controlled trials that were analyzed involved 3701 patients. There were 550 MACE (29.76%) in the platelet function monitored group compared with 514 (27.74%) in the control. MACE (Figure 1) was not significantly higher for the platelet function monitored group during follow-up compared with control (pooled Odds Ratio:1.11 [95% CI: 0.96-1.28], p = 0.15). Tests for heterogeneity were not significant, with I2 of 0%, Chi2 = 1.52 (p = 0.47); and small study bias was absent on visual inspection of the funnel plot. Conclusions: Platelet function monitoring continues to be used in practice. Results from this meta-analysis show no benefit of platelet function monitoring compared with conventional strategy with regards to MACE after PCI. Future research is needed to further evaluate this finding.

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Abstract 2356: Dual Antiplatelet Therapy following Percutaneous Coronary Intervention with Stent Implantation in Patients on Chronic Oral Anticoagulation

Circulation ◽

10.1161/circ.116.suppl_16.ii_516-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Renata Rogacka ◽

Alaide Chieffo ◽

Iassen Michev ◽

Flavio Airoldi ◽

Azeem Latib ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Triple Therapy ◽

Antiplatelet Therapy ◽

Major Bleeding ◽

Stent Implantation ◽

Dual Antiplatelet Therapy ◽

Coronary Intervention ◽

Bleeding Complications ◽

Percutaneous Coronary

Objectives: To evaluate the safety of dual antiplatelet therapy in patients in whom long-term anticoagulation (AC) with warfarin is recommended. Background: It is well established that antiplatelet therapy with aspirin ad thienopiridines is required following percutaneous coronary intervention (PCI) with stent implantation. Some patients have also indication for long-term AC. The optimal antithrombotic strategy following PCI in such patients is unclear. Methods: All consecutive patients who underwent PCI with stent implantation discharged on triple therapy (defined as the combination of aspirin and thienopyridines and AC with warfarin) were analyzed. Results One-hundred and twenty-seven patients with 224 lesions: 86.6% males, mean age 69.9±8.8 years were included in the study. Drug-eluting stents (DES) were positioned in 71 (55.9%) and bare metal stent (BMS) in 53 (41.7%) patients. Atrial fibrillation (AF) was the main indication (59.1%) for AC treatment, followed by prosthetic valves (12.4%) and mural left ventricular (LV) thrombus (9.1%). Average risk of thromboembolic events in the subgroup with AF was 1.79 ± 1.23 according to CHADS2 score. The mean triple therapy duration was 5.6±4.6 and clinical follow-up 21.0±19.8 months. During the triple therapy period, 6 patients (4.7%) developed major bleeding complications; 67% of which occurred within the first month. No significant differences between DES and BMS were observed in the incidence of major (respectively 5.6% vs. 3.8%, p=1.0) and minor bleeding (respectively 1.4% vs. 3.8%, p=0.57) and mortality (respectively 5.6% vs. 1.9%, p=0.39). Four patients died in DES group: 3 of major bleeding complications and one of ischemic stroke. The only death in the BMS group was due to subarachnoid hemorrhage. A significant difference was observed in favor of DES in target vessel revascularization (14.1% vs. 28.3%, p=0.041). Conclusions: While on triple therapy, major bleeding complications occurred in 4.7% of patients, half of them were lethal and most (67%) occurred within the first month.

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Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention

Journal of Cardiology ◽

10.1016/j.jjcc.2019.01.008 ◽

2019 ◽

Vol 74 (2) ◽

pp. 116-122 ◽

Cited By ~ 4

Author(s):

Takuya Nakahashi ◽

Hayato Tada ◽

Kenji Sakata ◽

Yohei Yakuta ◽

Yoshihiro Tanaka ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Ankle Brachial Index ◽

Coronary Intervention ◽

Bleeding Complications ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Long Term Mortality

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Major Femoral Bleeding Complications After Percutaneous Coronary Intervention

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2007.12.006 ◽

2008 ◽

Vol 1 (2) ◽

pp. 202-209 ◽

Cited By ~ 169

Author(s):

Brendan J. Doyle ◽

Henry H. Ting ◽

Malcolm R. Bell ◽

Ryan J. Lennon ◽

Verghese Mathew ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Bleeding Complications ◽

Percutaneous Coronary

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Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽

10.1136/bmjopen-2020-038042 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038042

Author(s):

Thomas A Meijers ◽

Adel Aminian ◽

Koen Teeuwen ◽

Marleen van Wely ◽

Thomas Schmitz ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Vascular Complications ◽

Coronary Intervention ◽

Ethics Committee ◽

Bleeding Complications ◽

Access Site ◽

Femoral Access ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

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Percutaneous Coronary Intervention–Related Bleeding Risk Factors in Current Practice

Annals of Pharmacotherapy ◽

10.1345/aph.1g057 ◽

2005 ◽

Vol 39 (10) ◽

pp. 1627-1633 ◽

Cited By ~ 7

Author(s):

A Scott Mathis ◽

James J Gugger

Keyword(s):

Risk Factors ◽

Percutaneous Coronary Intervention ◽

Renal Function ◽

Length Of Stay ◽

Bleeding Risk ◽

Coronary Intervention ◽

Bleeding Complications ◽

Minor Bleeding ◽

Prolonged Length ◽

Percutaneous Coronary

BACKGROUND: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Little is known about the risk factors for bleeding complications. Objective: To report our PCI-related observations from a single institution and use the information to establish risk factors for short-term bleeding complications, with special focus on examining the importance of renal function. METHODS: A retrospective record review was conducted of the admission of 300 patients grouped according to antithrombotic regimen: unfractionated heparin alone (n = 187), bivalirudin (n = 26), and glycoprotein IIb/IIIa antagonist plus heparin (n = 103). Bleeding and ischemic outcomes were tracked. A model was constructed to predict independent bleeding risk factors. RESULTS: Treatment groups differed significantly regarding any bleeding (p = 0.001), minor bleeding (p < 0.001), and length of stay (p = 0.01). Multivariate predictors of any bleeding included antithrombotic regimen, creatinine clearance (Clcr) <30 mL/min, and hypertension. Any bleeding was associated with prolonged length of stay. Major bleeding was predicted by Clcr <30 mL/min and was associated with prolonged length of stay and death. Minor bleeding was predicted only by choice of antithrombotic regimen. CONCLUSIONS: The major influences on bleeding risk appeared to be Clcr <30 mL/min and choice of antithrombotic regimen. It is important to note that other markers of renal function, including serum creatinine value and serum creatinine at a cutoff level of 1.5 mg/dL, did not predict bleeding events.

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