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Shi W, Fan X, Yang J, Ni L, Su S, Yu M, Yang H, Yu M, Yang Y. In-hospital gastrointestinal bleeding in patients with acute myocardial infarction: incidence, outcomes and risk factors analysis from China Acute Myocardial Infarction Registry. BMJ Open 2021; 11:e044117. [PMID: 34493500 PMCID: PMC8424832 DOI: 10.1136/bmjopen-2020-044117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the incidence of gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI), clarify the association between adverse clinical outcomes and GIB and identify risk factors for in-hospital GIB after AMI. DESIGN Retrospective cohort study. SETTING 108 hospitals across three levels in China. PARTICIPANTS From 1 January 2013 to 31 August 2014, after excluding 2659 patients because of incorrect age and missing GIB data, 23 794 patients with AMI from 108 hospitals enrolled in the China Acute Myocardial Infarction Registry were divided into GIB-positive (n=282) and GIB-negative (n=23 512) groups and were compared. PRIMARY AND SECONDARY OUTCOME MEASURES Major adverse cardiovascular and cerebrovascular events (MACCEs) are a composite of all-cause death, reinfarction and stroke. The association between GIB and endpoints was examined using multivariate logistic regression and Cox proportional hazards models. Independent risk factors associated with GIB were identified using multivariate logistic regression analysis. RESULTS The incidence of in-hospital GIB in patients with AMI was 1.19%. GIB was significantly associated with an increased risk of MACCEs both in-hospital (OR 2.314; p<0.001) and at 2-year follow-up (HR 1.407; p=0.0008). Glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitor, percutaneous coronary intervention (PCI) and thrombolysis were novel independent risk factors for GIB identified in the Chinese AMI population (p<0.05). CONCLUSIONS GIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor. TRIAL REGISTRATION NUMBER NCT01874691.
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Affiliation(s)
- Wence Shi
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, China
| | - Xiaoxue Fan
- Coronary Heart Disease Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Yang
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, China
| | - Lin Ni
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, China
| | - Shuhong Su
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, China
| | - Mei Yu
- Department of Cardiology, LangFang People's Hospital,HeBei Province, Langfang, China
| | - Hongmei Yang
- Department of Cardiology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Mengyue Yu
- Department of Cardiology and bMedical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, China
| | - Yuejin Yang
- Coronary Heart Disease Center, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, China
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Barthélémy O, Cayla G, Montalescot G. Should Hemoglobin Drop Be Added to Bleeding Classifications in ACS? J Am Coll Cardiol 2021; 77:389-391. [PMID: 33509395 DOI: 10.1016/j.jacc.2020.11.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Group, INSERM UMRS_1166 Institut de cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
| | - Guillaume Cayla
- Service de cardiologie CHU Nîmes, Université de Montpellier, ACTION Group, Montpellier, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Group, INSERM UMRS_1166 Institut de cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
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Guedeney P, Thiele H, Kerneis M, Barthélémy O, Baumann S, Sandri M, de Waha-Thiele S, Fuernau G, Rouanet S, Piek JJ, Landmesser U, Hauguel-Moreau M, Zeitouni M, Silvain J, Lattuca B, Windecker S, Collet JP, Desch S, Zeymer U, Montalescot G, Akin I. Radial versus femoral artery access for percutaneous coronary artery intervention in patients with acute myocardial infarction and multivessel disease complicated by cardiogenic shock: Subanalysis from the CULPRIT-SHOCK trial. Am Heart J 2020; 225:60-68. [PMID: 32497906 DOI: 10.1016/j.ahj.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use and impact of transradial artery access (TRA) compared to transfemoral artery access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) remain unclear. METHODS This is a post hoc analysis of the CULPRIT-SHOCK trial where patients presenting with MI and multivessel disease complicated by CS were randomized to a strategy of culprit-lesion-only or immediate multivessel PCI. Arterial access was left at operator's discretion. Adjudicated outcomes of interest were the composite of death or renal replacement therapy (RRT) at 30 days and 1 year. Multivariate logistic models were used to assess the association between the arterial access and outcomes. RESULTS Among the 673 analyzed patients, TRA and TFA were successfully performed in 118 (17.5%) and 555 (82.5%) patients, respectively. Compared to TFA, TRA was associated with a lower 30-day rate of death or RRT (37.3% vs 53.2%, adjusted odds ratio [aOR]: 0.57; 95% confidence interval [CI] 0.34-0.96), a lower 30-day rate of death (34.7% vs 49.7%; aOR: 0.56; 95% CI 0.33-0.96), and a lower 30-day rate of RRT (5.9% vs 15.9%; aOR: 0.40; 95% CI 0.16-0.97). No significant differences were observed regarding the 30-day risks of type 3 or 5 Bleeding Academic Research Consortium bleeding and stroke. The observed reduction of death or RRT and death with TRA was no longer significant at 1 year (44.9% vs 57.8%; aOR: 0.85; 95% CI 0.50-1.45 and 42.4% vs 55.5%, aOR: 0.78; 95% CI 0.46-1.32, respectively). CONCLUSIONS In patients undergoing PCI for acute MI complicated by CS, TRA may be associated with improved early outcomes, although the reason for this finding needs further research.
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Gilchrist IC. Gastrointestinal bleeding after percutaneous coronary intervention: Not just a short-term complication but a long-term marker of mortality risk. Catheter Cardiovasc Interv 2020; 95:E146-E147. [PMID: 31957914 DOI: 10.1002/ccd.28680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/11/2022]
Abstract
The incidence of gastrointestinal (GI) bleeding after percutaneous coronary interventional has remained stable recently although those undergoing treatment for ST-elevation myocardial infarction appear to be doing better. Short-term prognosis is worsened after a GI bleed and this adverse outcome persists out to at least 1 year. Poor outcomes late after a GI bleed suggest persistence patient factors that require further study to understand who is at risk, whether short-term measures can prevent bleeding, and whether interventions after bleeding can improve long-term outcomes.
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Affiliation(s)
- Ian C Gilchrist
- Heart and Vascular Institute, Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center, Hershey, Pennsylvania
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Abstract
The need for extracorporeal membrane oxygenation (ECMO) therapy is a marker of disease severity for which multiple medications are required. The therapy causes physiologic changes that impact drug pharmacokinetics. These changes can lead to exposure-driven decreases in efficacy or increased incidence of side effects. The pharmacokinetic changes are drug specific and largely undefined for most drugs. We review available drug dosing data and provide guidance for use in the ECMO patient population.
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Khoury H, Lavoie L, Welner S, Folkerts K. The Burden of Major Adverse Cardiac Events and Antiplatelet Prevention in Patients with Coronary or Peripheral Arterial Disease. Cardiovasc Ther 2017; 34:115-24. [PMID: 26670723 DOI: 10.1111/1755-5922.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patients with a history of a cardiovascular (CV) disease are at high risk of suffering secondary major adverse cardiac events (MACE), namely death, nonfatal myocardial infarction (MI), stroke, symptomatic pulmonary embolism, CV and all-cause hospitalization, and bleeding. METHODS A comprehensive review of the literature was conducted to review the epidemiology and burden of MACE in patients with coronary or peripheral arterial disease (CAD or PAD) in Europe and other ex-US regions. Relevant articles published between 2003 and 2013 were retrieved from PubMed and other sites. RESULTS MACE incidence and prevalence in patients with CAD or PAD were increased by at least 1.4-fold compared with matched controls with no CV disease. In patients with CAD, MACE mostly occurred within 30 days of primary percutaneous coronary intervention; incidence decreased with time. Increased oxidative stress in coronary and peripheral arteries, diabetes, and chronic kidney disease were identified as the main risk factors for MACE in patients with CAD and PAD. Registry data showed that, although preventive antiplatelet therapy was prescribed at high rates, a large proportion (9-56%) of patients did not receive treatment. Furthermore, adherence to treatment declined over time, potentially leading to disease worsening. CONCLUSION Despite gaps in the literature, this assessment showed that MACE's risk is substantial among patients with CAD or PAD and that the use of preventive therapies is suboptimal. Development of additional preventive therapies for these patients is warranted.
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One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2016; 109:337-47. [PMID: 27079469 DOI: 10.1016/j.acvd.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/31/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little information is available on the long-term incidence of bleeding events after ST-segment elevation myocardial infarction (STEMI) with the current antithrombotic strategy. AIMS To evaluate the effect of bleedings for up to 12months on clinical events and therapeutic compliance in unselected STEMI patients treated with prasugrel or clopidogrel. METHODS Patients were treated with clopidogrel or prasugrel according to guidelines. The primary endpoint was first occurrence of a bleeding event from hospital discharge to 12months, assessed by the Bleeding Academic Research Consortium (BARC) classification using a dedicated questionnaire. Topography of bleedings, causes of premature cessation and ischaemic events were compared between clopidogrel- and prasugrel-treated patients. RESULTS A total of 390 patients were enrolled (211 in the prasugrel group, 179 in the clopidogrel group). Elderly, female and low-body weight patients were more likely to receive clopidogrel. At 12months, the incidence of major bleedings (BARC 3) was lower with prasugrel (1% vs 6%; P=0.02), mainly due to fewer transfusions. Elderly age was a risk factor for severe bleeding. Premature treatment cessation was related to ischaemic complications (P=0.03), and occurred more frequently with prasugrel (P=0.001). One-year mortality was very low (1.9 per 100 person-years, 95% confidence interval 0.9-4.0), and was higher in the clopidogrel group (P=0.03). CONCLUSIONS In this unselected STEMI population, the rate of major bleedings with prasugrel at 12months was low, but nuisance bleedings were frequent and led to more premature cessations than with clopidogrel. Prevention of bleeding complications, even minor, is necessary to prevent disruption of antithrombotic medication.
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Loncar G, Barthelemy O, Berman E, Kerneis M, Petroni T, Payot L, Choussat R, Silvain J, Collet JP, Helft G, Montalescot G, Le Feuvre C. Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention. Arch Cardiovasc Dis 2015; 108:554-62. [DOI: 10.1016/j.acvd.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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Saab YB, Zeenny R, Ramadan WH. Optimizing clopidogrel dose response: a new clinical algorithm comprising CYP2C19 pharmacogenetics and drug interactions. Ther Clin Risk Manag 2015; 11:1421-7. [PMID: 26445541 PMCID: PMC4590670 DOI: 10.2147/tcrm.s83293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Response to clopidogrel varies widely with nonresponse rates ranging from 4% to 30%. A reduced function of the gene variant of the CYP2C19 has been associated with lower drug metabolite levels, and hence diminished platelet inhibition. Drugs that alter CYP2C19 activity may also mimic genetic variants. The aim of the study is to investigate the cumulative effect of CYP2C19 gene polymorphisms and drug interactions that affects clopidogrel dosing, and apply it into a new clinical-pharmacogenetic algorithm that can be used by clinicians in optimizing clopidogrel-based treatment. METHOD Clopidogrel dose optimization was analyzed based on two main parameters that affect clopidogrel metabolite area under the curve: different CYP2C19 genotypes and concomitant drug intake. Clopidogrel adjusted dose was computed based on area under the curve ratios for different CYP2C19 genotypes when a drug interacting with CYP2C19 is added to clopidogrel treatment. A clinical-pharmacogenetic algorithm was developed based on whether clopidogrel shows 1) expected effect as per indication, 2) little or no effect, or 3) clinical features that patients experience and fit with clopidogrel adverse drug reactions. RESULTS The study results show that all patients under clopidogrel treatment, whose genotypes are different from *1*1, and concomitantly taking other drugs metabolized by CYP2C19 require clopidogrel dose adjustment. To get a therapeutic effect and avoid adverse drug reactions, therapeutic dose of 75 mg clopidogrel, for example, should be lowered to 6 mg or increased to 215 mg in patients with different genotypes. CONCLUSION The implementation of clopidogrel new algorithm has the potential to maximize the benefit of clopidogrel pharmacological therapy. Clinicians would be able to personalize treatment to enhance efficacy and limit toxicity.
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Affiliation(s)
- Yolande B Saab
- School of Pharmacy, Pharmaceutical Sciences Department, Lebanese American University, Byblos, Lebanon
| | - Rony Zeenny
- School of Pharmacy, Pharmacy Practice Department, Lebanese American University, Byblos, Lebanon
| | - Wijdan H Ramadan
- School of Pharmacy, Pharmacy Practice Department, Lebanese American University, Byblos, Lebanon
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Marti V, Brugaletta S, García-Picart J, Delgado G, Cequier A, Iñiguez A, Hernandez-Antolin R, Serruys P, Serra A, Sabaté M. Acceso radial frente a femoral en angioplastia por infarto agudo de miocardio con elevación del segmento ST con stent farmacoactivo de segunda generación. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Radial versus femoral access for angioplasty of ST-segment elevation acute myocardial infarction with second-generation drug-eluting stents. ACTA ACUST UNITED AC 2014; 68:47-53. [PMID: 25553939 DOI: 10.1016/j.rec.2014.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/20/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Invasive and pharmacological treatment of ST-segment elevation acute myocardial infarction reduces the rate of ischemic events but not bleeding complications. The objective of this study was to compare clinical results and bleeding complications between femoral and radial access routes in patients with ST-segment elevation acute myocardial infarction. METHODS An evaluation was performed of the population of the Examination study, a randomized, multicenter, clinical trial that included 1498 patients with ST-segment elevation acute myocardial infarction who underwent emergency angioplasty. Subanalysis of this population was conducted to compare patients by type of access (femoral vs radial). The primary end point was a composite of: all-cause death, myocardial infarction, revascularization, and bleeding. RESULTS Femoral and radial access routes were used in 825 (55%) and 673 (45%) patients, respectively. More bleeding complications (major and minor) were seen with femoral access than radial access (5.9% vs 2.8%; P<.004), largely due to a greater incidence of minor bleeding with femoral access (4.6% vs 1.9%; P=.005). After adjustment for confounders, survival analysis showed a reduction in the primary composite end point in patients with radial access (hazard ratio=0.73; 95% confidence interval, 0.56-0.96; P=.022). CONCLUSIONS In patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications.
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Khan R, Ly HQ. Transradial percutaneous coronary interventions in acute coronary syndrome. Am J Cardiol 2014; 114:160-8. [PMID: 24925803 DOI: 10.1016/j.amjcard.2014.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 01/26/2023]
Abstract
Transradial access (TRA) is becoming increasingly used worldwide for percutaneous coronary intervention (PCI) after acute coronary syndromes (ACS). TRA compared with transfemoral access has been noted to improve clinical outcomes in clinical trials and large registry cohort studies. However, much of the benefits of TRA PCI are noted in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI, where TRA PCI has been associated with reductions in major bleeding events and potentially lower short- and long-term mortality rates. Although much less data exist for TRA PCI in unstable angina and/or non-ST elevation myocardial infarction, similar reductions in bleeding and mortality have not been consistently described. Differences in outcome benefit with TRA PCI among various ACS subtypes may be attributable to the potentially increased inherent risk of periprocedural bleeding in STEMI compared with unstable angina and/or non-ST elevation myocardial infarction. Pre- and intra-procedural factors associated with STEMI treatment, such as use of pharmacoinvasive therapy and aggressive antithrombotic regimens likely increase bleeding risk in patients. In conclusion, this review describes the evidence for TRA PCI across the spectrum of ACS and highlights why differences in clinical benefit may exist among ACS subtypes.
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Kwok CS, Rao SV, Myint PK, Keavney B, Nolan J, Ludman PF, de Belder MA, Loke YK, Mamas MA. Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis. Open Heart 2014; 1:e000021. [PMID: 25332786 PMCID: PMC4195929 DOI: 10.1136/openhrt-2013-000021] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/11/2014] [Accepted: 01/18/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions. METHODS We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic. RESULTS 42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes. CONCLUSIONS Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.
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Affiliation(s)
- Chun Shing Kwok
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - Sunil V Rao
- Department of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Phyo K Myint
- Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Bernard Keavney
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - James Nolan
- Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Mark A de Belder
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mamas A Mamas
- Cardiovascular Institute, University of Manchester, Manchester, UK
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Capranzano P, Dangas G. Bivalirudin for primary percutaneous coronary intervention in acute myocardial infarction: the HORIZONS-AMI trial. Expert Rev Cardiovasc Ther 2014; 10:411-22. [DOI: 10.1586/erc.12.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Thromb Res 2013; 132:652-8. [DOI: 10.1016/j.thromres.2013.09.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/16/2013] [Accepted: 09/18/2013] [Indexed: 12/19/2022]
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In-hospital major bleeding and its clinical relevance in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2013; 112:1533-9. [PMID: 23953696 DOI: 10.1016/j.amjcard.2013.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 12/16/2022]
Abstract
Advances in antithrombotic therapy for ST elevation myocardial infarction (STEMI) enhance the risk of bleeding. Therefore, the incidence, determinants, and prognostic implications of in-hospital major bleeding after primary percutaneous coronary intervention for STEMI were investigated. In 963 consecutive patients, the incidence of bleeding was evaluated according to commonly used classifications including Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In Myocardial Infarction, Global Use of Strategies To Open coronary arteries, and Bleeding Academic Research Consortium. Multivariate regression analyses investigated determinants of bleeding and the relation between bleeding and 1-year all-cause mortality. Large variability in incidence existed depending on classification (1.3% to 21%). Female gender, heart rate, creatinine, multivessel disease, cardiogenic shock, and procedural failure were independently associated with bleeding. One-year mortality reached 10.2% in bleeders versus 2.0% in nonbleeders (p <0.001). Bleeding was independently associated with an increased risk of 1-year mortality (hazard ratio [HR] 2.41, p <0.017). Assessment of individual classifications confirmed the increased risk of mortality for Bleeding Academic Research Consortium (HR 2.27, p = 0.048), but not for Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In Myocardial Infarction, and Global Use of Strategies To Open coronary arteries bleeding. Thrombotic events occurred more frequently in bleeders (5.8% vs 1.5%, p <0.001); however, bleeding remained independently related to mortality with a negligible reduction in HR (2.25, p = 0.028) after adjustment. In conclusion, in-hospital major bleeding was frequently observed after STEMI, but a widespread variation in incidence existed depending on the applied definition. Patient and procedural characteristics were related to bleeding, allowing identification of high-risk patients. In-hospital major bleeding was independently associated with 1-year all-cause mortality; however, not all bleeding classifications proved equally relevant to prognosis. The relation between bleeding and mortality was shown not to be driven by the higher rate of thrombotic events among bleeders.
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Fujii T, Masuda N, Ijichi T, Kamiyama Y, Tanaka S, Nakazawa G, Shinozaki N, Matsukage T, Ogata N, Ikari Y. Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock. Catheter Cardiovasc Interv 2013; 83:E1-7. [DOI: 10.1002/ccd.24896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/06/2013] [Accepted: 02/18/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Toshiharu Fujii
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Naoki Masuda
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Takeshi Ijichi
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Yoshinari Kamiyama
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Shigemitsu Tanaka
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Gaku Nakazawa
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Norihiko Shinozaki
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Takashi Matsukage
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Nobuhiko Ogata
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Yuji Ikari
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
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Baklanov DV, Kim S, Marso SP, Subherwal S, Rao SV. Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry. Circ Cardiovasc Interv 2013; 6:347-53. [PMID: 23922144 DOI: 10.1161/circinterventions.113.000279] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bleeding is a common, noncardiac, preventable complication of percutaneous coronary intervention. We compared the relative safety of radial access and bivalirudin in percutaneous coronary intervention. METHODS AND RESULTS From CathPCI Registry, we determined the association between the site of arterial access, bivalirudin, and periprocedural bleeding rates in 501 017 patients. Radial access patients receiving heparin (radial group) were compared with those receiving bivalirudin (radial combination group). Femoral access patients who had bivalirudin and a vascular closure device served as a reference group (femoral group). An inverse probability weighting analysis incorporating propensity scores was used to compare groups. The overall rate of bleeding was 2.59%. It was 2.71% in the femoral group, 2.5% in the radial group, and 1.82% in the radial combination groups (P<0.001). When compared with femoral group, the adjusted odds ratio for bleeding was significantly lower for patients with radial combination group (odds ratio, 0.79; 95% confidence interval, 0.72-0.86), but not for radial group (odds ratio, 0.96; 95% confidence interval, 0.88-1.05), unless patients treated with IIb/IIIa were excluded (radial group-IIb/IIIa odds ratio, 0.84; 95% confidence interval, 0.75-0.94).The number needed to treat to prevent 1 bleeding event with radial combination group was 138, whereas the number needed to treat to prevent 1 bleeding event in high-bleeding risk patients was 68. CONCLUSIONS In this observational analysis, the combination of bivalirudin and radial access was associated with reduced bleeding event rate. This benefit was present across the entire spectrum of preprocedural risk of bleeding, with or without exposure to IIb/IIIa inhibitors. These data support an adequately powered randomized trial comparing bleeding avoidance strategies.
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Affiliation(s)
- Dmitri V Baklanov
- Division of Cardiology, Saint-Lukes Mid America Heart Institute, Kansas City, MO, USA
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Mamas MA, Ratib K, Routledge H, Neyses L, Fraser DG, de Belder M, Ludman PF, Nolan J. Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention: are the results of randomized trials achievable in clinical practice? JACC Cardiovasc Interv 2013; 6:698-706. [PMID: 23769648 DOI: 10.1016/j.jcin.2013.03.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/06/2013] [Accepted: 03/15/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to investigate the influence of access site utilization on mortality, major adverse cardiac and cardiovascular events (MACCE), bleeding, and vascular complications in a large number of patients treated by primary percutaneous coronary intervention (PPCI) in the United Kingdom over a 5-year period, through analysis of the British Cardiovascular Intervention Society database. BACKGROUND Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing PPCI. A significant proportion of such bleeding complications are related to the access site, and adoption of radial access may reduce these complications. These benefits have not previously been studied in a large unselected national population of PPCI patients. METHODS Mortality (30-day), MACCE (a composite of 30-day mortality and in-hospital myocardial re-infarction, target vessel revascularization, and cerebrovascular events), and bleeding and access site complications were studied based on transfemoral access (TFA) and transradial access (TRA) site utilization in PPCI STEMI patients. The influence of access site selection was studied in 46,128 PPCI patients; TFA was used in 28,091 patients and TRA in 18,037. Data were adjusted for potential confounders using Cox regression that accounted for the propensity to undergo radial or femoral approach. RESULTS TRA was independently associated with a lower 30-day mortality (hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.52 to 0.97; p < 0.05), in-hospital MACCE (HR: 0.73, 95% CI: 0.57 to 0.93; p < 0.05), major bleeding (HR: 0.37, 95% CI: 0.18 to 0.74; p < 0.01), and access site complications (HR: 0.38, 95% CI: 0.19 to 0.75; p < 0.01). CONCLUSIONS This analysis of a large number of PPCI procedures demonstrates that utilization of TRA is independently associated with major reductions in mortality, MACCE, major bleeding, and vascular complication rates.
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Affiliation(s)
- Mamas A Mamas
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
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Moody WE, Chue CD, Ludman PF, Chan YKC, Narayan G, Millington JM, Townend JN, Doshi SN. Bleeding outcomes after routine transradial primary angioplasty for acute myocardial infarction using eptifibatide and unfractionated heparin: A single-center experience following the HORIZONS-AMI trial. Catheter Cardiovasc Interv 2013; 82:E138-47. [DOI: 10.1002/ccd.24703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/07/2012] [Indexed: 11/07/2022]
Affiliation(s)
- William E. Moody
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Colin D. Chue
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Peter F. Ludman
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Yik-ki C. Chan
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Gautam Narayan
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Jenna M. Millington
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Jonathan N. Townend
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Sagar N. Doshi
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
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TransRadial Education and Therapeutics (TREAT): shifting the balance of safety and efficacy of antithrombotic agents in percutaneous coronary intervention: a report from the Cardiac Safety Research Consortium. Am Heart J 2013; 165:344-53.e1. [PMID: 23453103 DOI: 10.1016/j.ahj.2012.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 11/23/2022]
Abstract
Percutaneous coronary intervention (PCI) is an integral part of the treatment of coronary artery disease. The most common complication of PCI, bleeding, typically occurs at the vascular access site and is associated with short-term and long-term morbidity and mortality. Periprocedural bleeding also represents the primary safety concern of concomitant antithrombotic therapies essential for PCI success. Use of radial access for PCI reduces procedural bleeding and hence may change the risk profile and net clinical benefit of these drugs. This new drug-device safety interaction creates opportunities to advance the safe and effective use of antithrombotic agents during PCI. In June 2010 and March 2011, leaders from government, academia, professional societies, device manufacturing, and pharmaceutical industries convened for 2 think tank meetings. Titled TREAT I and II, these forums examined approaches to improve the overall safety of PCI by optimizing strategies for antithrombotic drug use and radial artery access. This article summarizes the content and proceedings of these sessions.
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