Key result
Acute coronary syndrome was associated with a significantly higher adjusted risk for major bleeding compared to stable coronary artery disease after percutaneous coronary intervention (HR 1.85), with a markedly higher risk within the first 30 days.
Why the study?
Data evaluating the effects of acute coronary syndrome relative to stable CAD on bleeding risk after PCI were scarce.
Does acute coronary syndrome presentation increase bleeding and ischemic risk compared to stable coronary artery disease in patients undergoing first PCI?
Cohort (n=13,258)
Yes
Does acute coronary syndrome presentation increase bleeding and ischemic risk compared to stable coronary artery disease in patients undergoing first PCI?
ACS presentation at the time of first PCI is associated with a significantly higher risk of major bleeding compared to stable CAD, particularly within the first 30 days, without an excess risk of MI or ischemic stroke.
ACS presentation may elevate early post-PCI bleeding beyond HBR alone; leaves open tailored DAPT duration in ACS/HBR patients.
BACKGROUND: Data evaluating the effects of acute coronary syndrome (ACS) relative to stable coronary artery disease (CAD) on bleeding risk after percutaneous coronary intervention (PCI) are scarce. METHODS AND RESULTS: From the CREDO-Kyoto Registry Cohort-3, 13,258 patients undergoing first PCI (5,521 ACS; 7,737 stable CAD) were identified. Patients were further stratified according to ACS presentation and Academic Research Consortium High Bleeding Risk (HBR): ACS/HBR: n=2,502; ACS/no-HBR: n=3,019; stable CAD/HBR: n=3,905; and stable CAD/no-HBR: n=3,832. The primary bleeding endpoint was Bleeding Academic Research Consortium 3/5 bleeding, whereas the primary ischemic endpoint was myocardial infarction (MI)/ischemic stroke. Compared with stable CAD, ACS was associated with a significantly higher adjusted risk for bleeding (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.68-2.03; P<0.0001), with a markedly higher risk within 30 days (HR 4.24; 95% CI 3.56-5.06; P<0.0001). Compared with the stable CAD/no-HBR group, the ACS/HBR, no-ACS/HBR, and ACS/no-HBR groups were associated with significantly higher adjusted risks for bleeding, with HRs of 3.05 (95% CI 2.64-3.54; P<0.0001), 1.89 (95% CI 1.66-2.15; P<0.0001), and 1.69 (95% CI 1.45-1.98; P<0.0001), respectively. There was no excess adjusted risk of the ACS relative to stable CAD group for MI/ischemic stroke (HR 1.07; 95% CI 0.94-1.22; P=0.33). CONCLUSIONS: Bleeding risk after PCI depended on both ACS presentation and HBR, with a significant effect of ACS within 30 days.
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Natsuaki et al. (2021) conducted a cohort in Coronary artery disease requiring percutaneous coronary intervention (n=13,258). Acute coronary syndrome vs. Stable coronary artery disease was evaluated on Major bleeding (Bleeding Academic Research Consortium Type 3 or 5 bleeding) (HR 1.85, 95% CI 1.68-2.03, p=<0.0001). Acute coronary syndrome was associated with a significantly higher adjusted risk for major bleeding compared to stable coronary artery disease after percutaneous coronary intervention (HR 1.85), with a markedly higher risk within the first 30 days.
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