Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions.

Koskinas, Konstantinos C; Räber, Lorenz; Zanchin, Thomas; Wenaweser, Peter Martin; Stortecky, Stefan; Moschovitis, Aris; Khattab, Ahmed Aziz; Pilgrim, Thomas; Blöchlinger, Stefan; Moro, Christina; Jüni, Peter; Meier, Bernhard; Heg, Dik; Windecker, Stephan (2015). Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions. Circulation: Cardiovascular interventions, 8(5), e002053. Lippincott Williams & Wilkins 10.1161/CIRCINTERVENTIONS.114.002053

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BACKGROUND The risk factors and clinical sequelae of gastrointestinal bleeding (GIB) in the current era of drug-eluting stents, prolonged dual antiplatelet therapy, and potent P2Y12 inhibitors are not well established. We determined the frequency, predictors, and clinical impact of GIB after percutaneous coronary interventions (PCIs) in a contemporary cohort of consecutive patients treated with unrestricted use of drug-eluting stents. METHODS AND RESULTS Between 2009 and 2012, all consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Bleeding Academic Research Consortium (BARC) GIB and cardiovascular outcomes were recorded within 1 year of follow-up. Among 6212 patients, 84.1% received new-generation drug-eluting stents and 19.5% received prasugrel. At 1 year, GIB had occurred in 65 patients (1.04%); 70.8% of all events and 84.4% of BARC ≥3B events were recorded >30 days after PCI. The majority of events (64.4%) were related to upper GIB with a more delayed time course compared with lower GIB. Increasing age, previous GIB, history of malignancy, smoking, and triple antithrombotic therapy (ie, oral anticoagulation plus dual antiplatelet therapy) were independent predictors of GIB in multivariable analysis. GIB was associated with increased all-cause mortality (adjusted hazard ratio, 3.40; 95% confidence interval, 1.67-6.92; P=0.001) and the composite of death, myocardial infarction, or stroke (adjusted hazard ratio, 3.75; 95% confidence interval, 1.99-7.07; P<0.001) and was an independent predictor of all-cause mortality during 1 year. CONCLUSIONS Among unselected patients undergoing PCI, GIB has a profound effect on prognosis. Triple antithrombotic therapy emerged as the single drug-related predictor of GIB in addition to patient-related risk factors within 1 year of PCI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Räber, Lorenz; Wenaweser, Peter Martin; Stortecky, Stefan; Moschovitis, Aris; Khattab, Ahmed Aziz; Pilgrim, Thomas; Blöchlinger, Stefan; Jüni, Peter; Meier, Bernhard; Heg, Dierik Hans and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1941-7632

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

27 May 2015 10:38

Last Modified:

16 Jun 2016 10:16

Publisher DOI:

10.1161/CIRCINTERVENTIONS.114.002053

PubMed ID:

25910501

Additional Information:

Koskinas & Räber contributed equally to this work.

Uncontrolled Keywords:

antiplatelet drug; gastrointestinal hemorrhage; percutaneous coronary intervention

BORIS DOI:

10.7892/boris.68977

URI:

https://boris.unibe.ch/id/eprint/68977

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