Time-Dependent Associations Between Actionable Bleeding, Coronary Thrombotic Events, and Mortality Following Percutaneous Coronary Intervention: Results From the PARIS Registry.

Published

Journal Article

OBJECTIVES: The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention (PCI). BACKGROUND: The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized. METHODS: A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 patients undergoing PCI with stent implantation. CTE included definite or probable stent thrombosis or myocardial infarction. AB was defined as Bleeding Academic Research Consortium type 2 or 3. Associations between CTE and AB, both of which were modeled as time-dependent covariates, and 2-year mortality risk were examined using extended Cox regression. RESULTS: Over 2 years, the cumulative incidence of CTE, AB, and all-cause mortality was 5.9% (n = 289), 8.1% (n = 391), and 4.7% (n = 227), respectively. Adjusted hazard ratios for mortality associated with CTE and AB were 3.3 (95% confidence interval: 2.2 to 4.9) and 3.5 (95% confidence interval: 2.3 to 5.4), respectively. Temporal gradients in risk after either event were highest in the first 30 days and declined rapidly thereafter. Thrombotic events occurring while patients were on versus off dual-antiplatelet therapy were associated with a higher mortality risk, whereas risk related to AB was not influenced by dual-antiplatelet therapy status at the time of bleeding. CONCLUSIONS: Intracoronary thrombosis and AB are associated with mortality risks of comparable magnitude over a 2-year period after PCI, findings that might inform risk/benefit calculations for extension versus discontinuation of dual-antiplatelet therapy.

Full Text

Duke Authors

Cited Authors

  • Baber, U; Dangas, G; Chandrasekhar, J; Sartori, S; Steg, PG; Cohen, DJ; Giustino, G; Ariti, C; Witzenbichler, B; Henry, TD; Kini, AS; Krucoff, MW; Gibson, CM; Chieffo, A; Moliterno, DJ; Weisz, G; Colombo, A; Pocock, S; Mehran, R

Published Date

  • July 11, 2016

Published In

Volume / Issue

  • 9 / 13

Start / End Page

  • 1349 - 1357

PubMed ID

  • 27388822

Pubmed Central ID

  • 27388822

Electronic International Standard Serial Number (EISSN)

  • 1876-7605

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2016.04.009

Language

  • eng

Conference Location

  • United States