TY - JOUR
T1 - Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries
AU - D'Ascenzo, Fabrizio
AU - Biolè, Carloalberto
AU - Raposeiras-Roubin, Sergio
AU - Gaido, Federico
AU - Abu-Assi, Emad
AU - Kinnaird, Tim
AU - Ariza-Solé, Albert
AU - Liebetrau, Christoph
AU - Manzano-Fernández, Sergio
AU - Boccuzzi, Giacomo
AU - Henriques, Jose Paulo Simao
AU - Templin, Christian
AU - Wilton, Stephen B.
AU - Omedè, Pierluigi
AU - Velicki, Lazar
AU - Xanthopoulou, Ioanna
AU - Correia, Luis
AU - Cerrato, Enrico
AU - Rognoni, Andrea
AU - Fabrizio, Ugo
AU - Nuñez-Gil, Iván
AU - Montabone, Andrea
AU - Taha, Salma
AU - Fujii, Toshiharu
AU - Durante, Alessandro
AU - Song, Xiantao
AU - Gili, Sebastiano
AU - Magnani, Giulia
AU - Autelli, Michele
AU - Bongiovanni, Federica
AU - Grosso, Alberto
AU - Kawaji, Tetsuma
AU - Blanco, Pedro Flores
AU - Garay, Alberto
AU - Quadri, Giorgio
AU - Alexopoulos, Dimitrios
AU - Queija, Berenice Caneiro
AU - Huczek, Zenon
AU - Paz, Rafael Cobas
AU - González-Juanatey, José Ramón
AU - Fernández, María Cespón
AU - Nie, Shao-Ping
AU - Pousa, Isabel Muñoz
AU - Kawashiri, Masa-aki
AU - Rettegno, Sara
AU - Gallo, Diego
AU - Morbiducci, Umberto
AU - Conrotto, Federico
AU - Dominguez-Rodriguez, Alberto
AU - Valdés, Mariano
AU - Cequier, Angel
AU - Iñiguez-Romo, Andrés
AU - Biondi-Zoccai, Giuseppe
AU - Stone, Gregg W.
AU - de Ferrari, Gaetano Maria
PY - 2020/2
Y1 - 2020/2
N2 - Background: The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies. Methods: BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup. Results: A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P =.886). In the first 2 weeks ADIR was higher than ADBR (P =.013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P =.003), whereas non–ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P =.012 and P =.022, respectively). Conclusions: In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non–ST-segment elevation ACS patients and in those discharged on ticagrelor.
AB - Background: The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies. Methods: BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup. Results: A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P =.886). In the first 2 weeks ADIR was higher than ADBR (P =.013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P =.003), whereas non–ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P =.012 and P =.022, respectively). Conclusions: In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non–ST-segment elevation ACS patients and in those discharged on ticagrelor.
UR - http://www.scopus.com/inward/record.url?scp=85075840085&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ahj.2019.10.001
DO - https://doi.org/10.1016/j.ahj.2019.10.001
M3 - Article
C2 - 31809991
SN - 0002-8703
VL - 220
SP - 108
EP - 115
JO - American Heart Journal
JF - American Heart Journal
ER -