scholarly journals A dynamic model to estimate evolving risk of major bleeding after percutaneous coronary intervention

2021 ◽  
Author(s):  
Nathan C Hurley ◽  
Nihar Desai ◽  
Sanket Dhruva ◽  
Rohan Khera ◽  
Wade L Schulz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Clinical Information ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Initial Model ◽  
Moderate Risk ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary

Background: Bleeding is a common complication of percutaneous coronary intervention (PCI), leading to significant morbidity, mortality, and cost. While several risk models exist to predict post-PCI bleeding risk, however these existing models produce a single estimate of bleeding risk anchored at a single point in time. These models do not update the risk estimates as new clinical information emerges, despite the dynamic nature of risk. Objective: We sought to develop models that update estimates of patient risk of bleeding over time, enabling a dynamic estimate of risk that incorporates evolving clinical information, and to demonstrate updated predictive performance by incorporating this information. Methods: Using data available from the National Cardiovascular Data Registry (NCDR) CathPCI, we trained 6 different XGBoost tree-based machine learning models to estimate the risk of bleeding at key decision points: 1) choice of access site, 2) prescription of medication prior to PCI, and 3) the choice of closure device. Results: We included 2,868,808 PCIs; 2,314,446 (80.7%) prior to 2014 for training and 554,362 (19.3%) remaining for validation. Discrimination improved from an AUROC of 0.812 (95% Confidence Interval: 0.812-0.812) using only presentation variables to 0.845 (0.845-0.845) using all variables. Among 123,712 patients classified as low risk by the initial model, 14,441 were reclassified as moderate risk (1.4% experienced bleeds), while 723 patients were reclassified as high risk (12.5% experienced bleeds). Among 160,165 patients classified as high risk by the initial model, there were 40 patients reclassified to low risk (0% experienced bleeds), and 43,265 patients reclassified to moderate risk (2.5% experienced bleeds). Conclusion: Accounting for the time-varying nature of data and capturing the association between treatment decisions and changes in risk provide up-to-date information that may guide individualized care throughout a hospitalization.

The Preventive Effect of Alprostadil on the Contrast-Induced Nephropathy of Coronary Heart Disease Treated by Percutaneous Coronary Intervention in Moderate and High-Risk Population Stratified by Mehran Score

Angiology ◽  
2021 ◽  
pp. 000331972110155
Author(s):  
Xiaogang Liu ◽  
Peng Zhang ◽  
Jing Zhang ◽  
Xue Zhang ◽  
Shicheng Yang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
High Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Preventive Effect ◽  
Moderate Risk ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

The Mehran risk score (MRS) was used to classify patients with coronary heart disease and evaluate the preventive effect of alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. The patients (n = 1146) were randomized into an alprostadil and control group and then divided into 3 groups on the basis of the MRS: low-risk, moderate-risk, and high-risk groups. The primary end point was the occurrence of CIN (alprostadil + hydration vs simple hydration treatment); secondary end points included serum creatinine, blood urea nitrogen, creatinine clearance rate, cystatin C, interleukin-6, C-reactive protein, proteinuria, and differences in the incidence of major adverse events. In the low-risk, moderate-risk, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 versus 2.6% ( P = .832), 11.4 versus 4.9% ( P = .030), 19.1 versus 7.7% ( P = .041), respectively. Multivariate logistic regression analysis showed that alprostadil treatment was a favorable protective factor for moderate-risk and high-risk CIN patients (OR = 0.343, 95% CI: 0.124-0.951, P = .040). Alprostadil can be used as a preventive treatment for moderate- and high-risk CIN patients classified by the MRS. The reduction of CIN by alprostadil may be related to an anti-inflammatory effect.

Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high risk diabetics stratified by mehran score

Perfusion ◽  
2020 ◽  
pp. 026765912095205
Author(s):  
Xue Zhang ◽  
Peng Zhang ◽  
Shicheng Yang ◽  
Wenyuan Li ◽  
Xiuzhen Men ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Serum Creatinine ◽  
Coronary Intervention ◽  
Low Risk ◽  
Control Group ◽  
Preventive Effect ◽  
Contrast Induced Nephropathy ◽  
Risk Population ◽  
Percutaneous Coronary

Background: The aim of this research was to use the Mehran risk score to classify elderly diabetics with coronary heart disease to assess the preventive effect of trimetazidine on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in different risk population. Methods: An uncompromised of 760 elderly diabetics that went through PCI were included in this research. The patients were first divided into three groups in the light of MRS: low-risk, moderate-risk, and high-risk group, then randomized into trimetazidine group and the control group respectively. The first endpoint was the amount of CIN, which is described as a rise in serum creatinine levels by ⩾44.2 μmol/L or ⩾25% ratio within 48 or 72 hours after medication. Second endpoint included differences in creatinine clearance rate (CrCl), blood urea nitrogen (BUN), serum creatinine (Scr), cystatin-C (Cys-C), and the incidence of major adverse events after administration. Results: In the three groups, the incidence of CIN in trimetazidine and control group was 5.0% versus 4.9%(χ2 = 0.005, p > 0.05), 8.0% versus 18.0% (χ2 = 7.685, p < 0.05), 10.4% versus 27.1% (χ2 = 4.376, p < 0.05), respectively. The multivariable logistic regression result demonstrated that trimetazidine intervention was a profitable element of CIN in moderate and high-risk groups (OR = 0.294, 95% CI 0.094-0.920, p = 0.035). Conclusion: Our study confirmed that trimetazidine can be considered for preventive treatment of CIN occurrence in elderly diabetics with moderate and high-risk population, while there is no obvious advantage compared with hydration therapy in low-risk patients.

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are We Now?

2018 ◽  
Vol 52 (9) ◽  
pp. 884-897 ◽  
Author(s):  
Ryan G. D’Angelo ◽  
Thaddeus McGiness ◽  
Laura H. Waite
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Current Evidence ◽  
Patient Specific ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI). Data Sources: PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy. Study Selection and Data Extraction: The results included randomized and nonrandomized clinical trials and meta-analyses. Each study was reported based on study design, population, intervention, comparator, and key cardiovascular (CV) and bleeding outcomes. Data Synthesis: A total of 15 studies were included in the review. The majority of studies evaluating DT and TT utilized clopidogrel and warfarin as components of the regimen, although there are emerging data with newer agents. Evidence purporting DT regimens to be equally effective in preventing CV events and improved safety profiles compared with TT regimens included populations with relatively low risk for recurrent CV events, and many of these studies were observational in nature. Overall, current evidence as well as American and European guidelines support the use of TT in patients with AF who require PCI for the least possible amount of time, depending on patient-specific factors involving bleeding and thrombosis. Conclusions: In the majority of patients with AF who require PCI, TT should be used for the shortest period of time possible. DT regimens may be used in patients requiring PCI who have low risk for thrombosis and/or high bleeding risk.

scholarly journals Bleeding Risk Profile in Patients on Oral Anticoagulation Undergoing Percutaneous Coronary Interventions: A Prospective 24 Months Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Sara Schukraft ◽  
Tibor Huwyler ◽  
Cindy Ottiger-Mankaka ◽  
Sonja Lehmann ◽  
Ezia Cook ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Oral Anticoagulation ◽  
Academic Research ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary ◽  
High Bleeding Risk

Background: The Academic Research Consortium has identified a set of major and minor risk factors in order to standardize the definition of a high bleeding risk (ACR-HBR). Oral anticoagulation is a major criterion frequently observed.Aims: The objective of this study is to quantify the risk of bleeding in patients on oral anticoagulation with at least one additional major ACR-HBR criteria in the Cardio-Fribourg Registry.Methods: Between 2015 and 2017, consecutive patients undergoing percutaneous coronary intervention were prospectively included in the Cardio-Fribourg registry. The study population included patients with ongoing long-term oral anticoagulation (OAC) and planned to receive triple antithrombotic therapy. Patients were divided in two groups: patients on OAC with at least one additional major ACR-HBR criteria vs. patients on OAC without additional major ACR-HBR criteria. The primary endpoint was any bleeding during the 24-month follow-up. Secondary bleeding endpoint was defined as Bleeding Academic Research Classification (BARC) ≥3.Results: Follow-up was completed in 142 patients at high bleeding risk on OAC, of which 33 (23%) had at least one additional major ACR-HBR criteria. The rate of the primary endpoint was 55% in patients on OAC with at least one additional ACR-HBR criteria compared with 14% in patients on OAC without additional ACR-HBR criteria (hazard ratio, 3.88; 95%CI, 1.85–8.14; p &lt; 0.01). Patients with additional major ACR-HBR criteria also experienced significantly higher rates of BARC ≥ 3 bleedings (39% at 24 months).Conclusion: The presence of at least one additional ACR-HBR criterion identifies patients on OAC who are at very high risk of bleeding after percutaneous coronary intervention.

scholarly journals Management of anti-thrombotic therapy in patients with recent percutaneous coronary intervention and acute dengue infection: A case series

2019 ◽  
Vol 28 (4) ◽  
pp. 284-287
Author(s):  
Wishnu Aditya ◽  
Jonathan Yap ◽  
Piotr Chlebicki ◽  
Charles Wah Hak Chan ◽  
Jack Wei Chieh Tan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Dengue Infection ◽  
Case Series ◽  
Coronary Intervention ◽  
Careful Consideration ◽  
Risk Of Bleeding ◽  
Anti Platelet Therapy ◽  
Percutaneous Coronary ◽  
The Ideal

There is currently little data regarding the ideal management for a patient who has undergone recent percutaneous coronary intervention (PCI) and subsequently develops dengue fever. Patients with recent PCI are at high risk of stent thrombosis with cessation of dual anti-platelet therapy. On the other hand, patients with dengue viral infection are at high risk of bleeding. Managing patients with recent PCI and dengue involves the delicate balancing of the risk of thrombosis and bleeding. Careful consideration of the timing of coronary intervention and the severity of the dengue infection is required. We describe the management of the anti-thrombotic therapy in three different patients with dengue infection and recent PCI and discuss our approach to managing such patients.

scholarly journals Antithrombotic therapy in patients with atrial fibrillation and percutaneous coronary intervention: what has changed in the guidelines in 2020?

2020 ◽  
pp. 56-64
Author(s):  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Antiplatelet Drug ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary

The article presents an analytical review of the studies aimed at determining the optimal antithrombotic therapy in patients with atrial fibrillation undergoing elective or emergency percutaneous coronary intervention (PCI) due to the development of acute coronary syndrome (ACS). The results of the WOEST study are analysed. This study was the first to demonstrate an opportunity to safely discontinue administration of aspirin as part of the multicomponent antithrombotic therapy that included warfarin as an anticoagulant. Three studies were analysed - PIONEER AF-PCI, RE-DUAL-PCI and AUGUSTUS, where direct oral anticoagulants (DOACs) - rivaroxaban, dabigatran and apixaban were used as anticoagulants as part of the multicomponent therapy. The results of these studies formed the backbone of the updated European guidelines for the diagnosis and treatment of atrial fibrillation, 2020. The guidelines offer to divide patients with AF and ACS, who require multicomponent antithrombotic therapy, into two categories. The first group includes AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as patients with a risk of bleeding that prevails over the risk of stent thrombosis. The second category of patients, in contrast, is characterized by a high risk of stent thrombosis, which prevails over the risk of bleeding. In the absence of contraindications, the patients of both categories should choose DOAC as an anticoagulant and be prescribed clopidogrel as a P2Y12 inhibitor for 12 months. In AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as in patients with a risk of bleeding, which prevails over the risk of stent thrombosis, the period of treatment with the second antiplatelet drug (aspirin) should belimited to the hospital stay. Patients at increased risk of stent thrombosis and reduced risk of bleeding can extend the aspirin therapy for 1 month. The approaches to the choice of the duration and composition of the multicomponent antithrombotic therapy in AF patients taking oral anticoagulants after elective PCI are similar to those in ACS patients, except for the duration of clopidogrel therapy, which is reduced to 6 months in all patients.

Thrombosis and major bleeding risk after primary percutaneous coronary intervention among patients with multi-vessels coronary artery disease (Preprint)

2021 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Chen Liu ◽  
Peng Zhou ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Major Bleeding ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Primary Pci ◽  
Percutaneous Coronary

BACKGROUND The risk of thrombotic events (TEs), including myocardial infarction (MI) and ST, is lower in patients with acute coronary syndrome who receive dual antiplatelet therapy (DAPT) with aspirin or who have undergone primary percutaneous coronary intervention (PCI) OBJECTIVE Background and Aims The present study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multi-vessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI). METHODS TEs were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) 3 or 5 bleeding. The derivation and validation cohorts comprised 2976 patients who underwent primary PCI between January 2010 and June 2017. RESULTS At a median follow-up of 3.07 years (1122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.820 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n=755) was associated with a higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death, compared to low risk (n=1275) (p=0.0022, 0.019, 0.012, respectively). High bleeding risk (n=1675) was associated with a higher incidence of bleeding, MACEs, cardiac death, compared to low risk (n=355) (p<0.0001). CONCLUSIONS Conclusion Simple risk scores can be useful in predicting the risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

scholarly journals A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention

2020 ◽  
Vol 14 (2) ◽  
pp. 92
Author(s):  
George W Vetrovec ◽  
Amir Kaki ◽  
Thom G Dahle ◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Abstract 382: Risk Prediction Algorithm Accurately Identifies Patients at High Risk for 30-Day Readmission after Percutaneous Coronary Intervention

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Craig E Strauss ◽  
Brandon R Porten ◽  
Denise L Mueller ◽  
Ross F Garberich ◽  
Ivan J Chavez ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Risk Prediction ◽  
Coronary Intervention ◽  
Low Risk ◽  
Prediction Algorithm ◽  
Intermediate Risk ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
Readmission Risk

Background: Approximately 15% of Medicare patients who undergo percutaneous coronary intervention (PCI) are readmitted to the hospital within 30 days of discharge. A risk prediction algorithm which accurately identifies PCI patients’ risk for readmission may provide an opportunity to implement strategies to optimize care transitions to reduce inpatient readmissions and hospitalization costs in higher risk patients. Methods: We retrospectively applied a published validated 30-day readmission risk prediction algorithm to all PCI cases across three high volume centers within a single health care system between July 1, 2009 and September 30, 2013. Readmission risk scores were calculated and cases were grouped by low- (<6), intermediate- (6-10) and high-risk (≥11). Inpatient readmissions were compared between groups. Based on 4.25-year historical data and mean total variable costs per inpatient readmission, we assessed the impact of reducing the readmission rate by 50% in high-risk patients and 30% in intermediate-risk patients on readmissions per year and annual total variable costs. Results: Among 13,494 PCI cases, 1,237 (9.2%) were high-, 5,846 (43.3%) were intermediate- and 6,411 (47.5%) were low-risk. High-, intermediate- and low-risk groups had significantly different overall readmission rates (19.8% vs. 10.5% vs. 5.4%; p<0.001) (Figure). On average, there were 283 readmissions per year, and the mean total variable costs were $6,530 per inpatient readmission. Reducing readmissions by 50% in high-risk patients and 30% in intermediate-risk patients would reduce 72 inpatient readmissions per year and result in total variable costs savings of $470,160 annually. Conclusions: A risk prediction algorithm accurately identifies PCI patients at highest risk for hospital readmission. This tool may enable providers to implement targeted strategies to reduce 30-day readmissions and hospital costs through transition care conferences, registered nurse telephone contact, early clinical follow-up and care management.

Sign in / Sign up

Export Citation Format

Share Document