Key result
Elevated systolic blood pressure (≥20 mm Hg) during hospitalization for percutaneous coronary intervention was associated with a higher risk of 3-year major bleeding events (HR 1.885; 95% CI 1.294-2.748).
Why the study?
Hypertension is a known bleeding risk factor, but the effects of blood pressure and its changes on bleeding events after PCI remain poorly understood.
Does an increase in systolic blood pressure of ≥20 mm Hg during hospitalization increase the risk of 3-year major bleeding events in patients undergoing PCI?
Cohort (n=6,351)
Yes
Does an increase in systolic blood pressure of ≥20 mm Hg during hospitalization increase the risk of 3-year major bleeding events in patients undergoing PCI?
An increase in systolic blood pressure of ≥20 mm Hg during hospitalization for PCI is associated with nearly double the risk of major bleeding events over 3 years.
Should not alter periprocedural BP targets; leaves open whether SBP elevation predicts or causes post-PCI bleeding.
BACKGROUND: Hypertension is a risk factor for bleeding events and is included in the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol concomitantly)score. However, the effects of blood pressure (BP) and changes in BP on bleeding events in patients undergoing percutaneous coronary intervention (PCI) remain poorly understood. This study is aimed to investigate the relationship between systolic BP (SBP) changes during hospitalisation and bleeding events in patients undergoing PCI. METHODS: From the Clinical Deep Data Accumulation System database, a multicentre database encompassing seven tertiary medical hospitals in Japan that includes data for patient characteristics, medications, laboratory tests, physiological tests, cardiac catheterisation and PCI treatment, data for 6351 patients undergoing PCI between April 2013 and March 2019 were obtained. The study population was categorised into three groups based on the changes in SBP during hospitalisation: (1) elevated BP (≥20 mm Hg), (2) no change (≥-20 to <20 mm Hg) and (3) decreased BP (<-20 mm Hg) groups. The primary outcome was a 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria. RESULTS: The elevated BP group exhibited significantly lower SBP at admission and higher SBP at discharge (p<0.001). Multivariable Cox hazard regression models showed that elevated BP was associated with a high risk of bleeding events (HR: 1.885; 95% CI, 1.294 to 2.748). The multivariable logistic regression model identified female sex, chronic coronary syndrome, peripheral artery disease and chronic kidney disease as independent factors associated with elevated BP. CONCLUSIONS: These findings suggest that BP management is essential to prevent bleeding events after PCI.
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Otsuka et al. (2024) conducted a cohort in Percutaneous coronary intervention (n=6,351). Elevated systolic blood pressure (≥20 mm Hg) during hospitalisation vs. No change (≥-20 to <20 mm Hg) or decreased systolic blood pressure (<-20 mm Hg) was evaluated on 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria (HR 1.885, 95% CI 1.294 to 2.748). Elevated systolic blood pressure (≥20 mm Hg) during hospitalization for percutaneous coronary intervention was associated with a higher risk of 3-year major bleeding events (HR 1.885; 95% CI 1.294-2.748).
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