Effects of Acute Coronary Syndrome and Stable Coronary Artery Disease on Bleeding and Ischemic Risk After Percutaneous Coronary Intervention
Masahiro Natsuaki, Takeshi Morimoto, Hiroki Shiomi, Kazushige Kadota, Tomohisa Tada, Yasuaki Takeji, Yukiko Matsumura‐Nakano, Yusuke Yoshikawa, Hirotoshi Watanabe, Ko Yamamoto, Kazuaki Imada, Takenori Domei, Kyohei Yamaji, Kazuhisa Kaneda, Ryoji Taniguchi, Natsuhiko Ehara, Ryuzo Nawada, Mamoru Toyofuku, Eiji Shinoda, Satoru Suwa, Toshihiro Tamura, Tsukasa Inada, Mitsuo Matsuda, Takeshi Aoyama, Yukihito Sato, Yutaka Furukawa, Kenji Andò, Yoshihisa Nakagawa, Takeshi Kimura, for the CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators
Abstract
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.