Post-discharge Bleeding Common, Predictive of Mortality After PCI

 

Bleeding after leaving the hospital is a frequent problem among PCI patients and is associated with poorer outcomes up to 2 years after the procedure, according to results of a study presented at TCT 2014.

mon.genereux.figure1Philippe Généreux, MD, of Columbia University Medical Center in New York, and colleagues analyzed results from 8,582 patients included in the prospective ADAPT-DES registry who were treated with at least 1 drug-eluting stent (DES). Of 8,577 hospital survivors, post-discharge bleeding occurred in 610 (7.1%) at a median of 210 days after the index PCI.

Post-discharge bleeding was predictive of several adverse outcomes — including mortality — through 2 years (see Table 1).

Gastrointestinal bleeding was the most frequent type of post-discharge bleeding, accounting for 34.1% of cases. Généreux told TCT Daily that post-discharge bleeding was an even stronger predictor of mortality than MI. In a multivariable analysis that included the occurrence of MI after discharge as a time-dependent covariable, post-discharge bleeding was a powerful independent predictor of 2-year mortality (HR 3.91; 95% CI 2.90-5.27; P<.0001).

There were also a number of independent predictors of post-discharge bleeding, including in-hospital bleeding and warfarin use at discharge (see Table 2).

mon.genereux.figure2“We have a lot of data on periprocedural bleeding; we have a lot of data comparing access sites; and we have a lot of data regarding in-hospital bleeding — but we don’t have a lot of great data about bleeding after 30 days,” Généreux said. This study represents the largest such data set, he said, calling it a good first step toward customizing treatment for high-risk patients.

Généreux stressed that as PCI gets better and safer there is a tendency to use shorter DAPT durations; in that context, understanding the risk of bleeding is important. He added that some of the bleeding predictors do not come as a surprise because they represent markers of sicker patients in general.

The most important message is simply that of frequency, Généreux said: “The conclusion is that this is very common within 2 years — 1 patient out of 14 will have bleeding.”

  

Disclosures:

  • Généreux reports no relevant conflicts of interest.

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