Frequency and predictors of bleeding events after 2nd generation drug-eluting stent implantation differ depending on time after implantation. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Honda, Yohsuke; Yamawaki, Masahiro; Mori, Shinsuke; Shirai, Shigemitsu; Makino, Kenji; Tokuda, Takahiro; Maruyama, Takashi; Takafuji, Hiroya; Takama, Takuro; Tsutumi, Masakazu; Sakamoto, Yasunari; Takimura, Hideyuki; Kobayashi, Norihiro; Araki, Motoharu; Hirano, Keisuke; Sakai, Tsuyoshi; Ito, Yoshiaki
• Is Part Of: Journal of cardiology. Volume 69:Issue 4(2017:Apr.)
• Page Start: 632
• Page End: 639
• Publication Date: 2017-04
• Subjects: Drug-eluting stent -- Bleeding event -- Antithrombotic therapy -- Prognosis; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2016.05.017
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Antiplatelet therapy is required after drug-eluting stent (DES) implantation, but bleeding events occur unexpectedly. We aimed to assess whether bleeding event predictors after 2nd generation DES (2nd DES) implantation differed by time after implantation. Methods: We studied 1912 consecutive patients who underwent successful 2nd DES implantation (70 ± 10 years, 72% male). Bleeding events were recorded as early (≤1 year) and late (>1 year). Major bleeding events were defined as a composite of type 5, 3, and 2 bleeding in the Bleeding Academic Research Consortium criteria. Predictors were assessed using a Cox proportional hazard model. Results: Bleeding event rates were 3.3%, 5.1%, and 6.7% at 1, 2, and 3 years, respectively, with the highest 1-year rate in year 1 ( p < 0.001). Cause and severity of bleeding events were similar between early and late bleeding events. Prior history of gastrointestinal bleeding, non-steroidal anti-inflammatory drug use, and triple antithrombotic therapy [adjusted risk ratio (RR): 3.68, 3.21, 4.57, respectively; p < 0.01] were independent predictors of early bleeding events. Age >80 years and severe renal dysfunction (adjusted RR: 2.27, 2.02, respectively; p < 0.01) were independent predictors of late bleeding events. Survival rate was significantly lower in patients with bleeding events compared with patients without bleeding events (82.4% vs 90.1%; p < 0.001). Conclusion: Frequency and predictors of bleeding events after 2nd DES implantation differ by time after implantation. Treatment strategies corresponding to individual patients are required.