Incidence, Prediction, and Outcomes of Major Bleeding After Percutaneous Coronary Intervention in Chinese Patients

Andrew Kei-Yan Ng; Pauline Yeung Ng; April Ip; Ian Wood-Hay Ling; Lap-Tin Lam; Chung-Wah Siu

doi:10.1016/j.jacasi.2021.12.009

Incidence, Prediction, and Outcomes of Major Bleeding After Percutaneous Coronary Intervention in Chinese Patients

JACC Asia. 2022 Apr 26;2(3):341-350. doi: 10.1016/j.jacasi.2021.12.009. eCollection 2022 Jun.

Authors

Andrew Kei-Yan Ng¹, Pauline Yeung Ng^{2

3}, April Ip³, Ian Wood-Hay Ling¹, Lap-Tin Lam¹, Chung-Wah Siu⁴

Affiliations

¹ Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China.
² Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China.
³ Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁴ Department of Medicine, Queen Mary Hospital, The University of Hong Kong SAR, China.

Abstract

Background: The patterns of late major bleeding (MB) after percutaneous coronary intervention (PCI) remain unknown in Chinese patients.

Objectives: This study sought to determine the incidence, prediction, and long-term outcomes of late MB in Chinese patients.

Methods: This was a retrospective cohort study from 14 hospitals in Hong Kong. Participants were patients undergoing first-time PCI without MB within 30 days or death within 1 year. Patients were stratified by the presence of late MB, defined as MB between 30 and 365 days. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac events (MACE).

Results: A total of 32,057 patients were analyzed. After adjustment for baseline characteristics, periprocedural characteristics, and medications on discharge, the risks of all-cause mortality at 5 years were significantly higher with late MB (HR: 2.15; 95% CI: 1.92-2.41; P < 0.001). Late MB was also associated with a higher risk of MACE (HR: 1.57; 95% CI: 1.03-1.50; P < 0.001), myocardial infarction (HR: 1.25; 95% CI: 1.04-1.52; P = 0.02), and stroke (HR: 1.38; 95% CI: 1.09-1.73; P = 0.006). The CARDIAC (anti-Coagulation therapy, Age, Renal insufficiency, Drop In hemoglobin, baseline Anemia in Chinese patients) score had a good discriminating power for prediction of MB within 365 days (area under the receiver-operating characteristic curve: 0.76).

Conclusions: Late MB was independently associated with a higher risk of mortality, MACE, myocardial infarction, and stroke in patients undergoing PCI. The CARDIAC score is a simple model that can predict MB after PCI. Prevention of MB represents an important strategy to optimize cardiovascular outcomes for patients undergoing PCI.

Keywords: AUC, area under the curve; DAPT, dual antiplatelet therapy; MACE, major adverse cardiac events; MB, major bleeding; PCI, percutaneous coronary intervention; all-cause mortality; eGFR, estimated glomerular filtration rate; major adverse cardiac events; major bleeding; myocardial infarction; percutaneous coronary intervention; repeat revascularization; stroke.