Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention. Issue 2 (August 2019)

• Record Type: Journal Article
• Authors: Nakahashi, Takuya; Tada, Hayato; Sakata, Kenji; Yakuta, Yohei; Tanaka, Yoshihiro; Gamou, Tadatsugu; Nomura, Akihiro; Terai, Hidenobu; Horita, Yuki; Ikeda, Masatoshi; Namura, Masanobu; Takamura, Masayuki; Hayashi, Kenshi; Yamagishi, Masakazu; Kawashiri, Masa-aki
• Is Part Of: Journal of cardiology. Volume 74:Issue 2(2019)
• Page Start: 116
• Page End: 122
• Publication Date: 2019-08
• Subjects: Acute coronary syndrome -- Bleeding -- Percutaneous coronary intervention -- Peripheral artery disease; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2019.01.008
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: One-sixth of all patients with acute coronary syndrome (ACS) had concomitant peripheral artery disease as determined by decreased ankle-brachial index (ABI). Decreased ABI was one of the major predictors of 30-day bleeding in ACS patients. Combination of ABI and classical bleeding risk factors might help in risk assessment. Both decreased ABI and 30-day bleeding also affect long-term prognosis in ACS. Abstract: Background: Although concomitant peripheral artery disease in patients with acute coronary syndrome (ACS) has been considered as a high-risk subgroup with a greater incidence of bleeding after percutaneous coronary intervention (PCI), few data exist regarding the clinical utility of the ankle-brachial index (ABI) for predicting bleeding complications, which affects the subsequent outcome. Methods: Eight hundred and twenty-four consecutive patients with ACS who underwent PCI and ABI examination were analyzed retrospectively. Decreased-ABI was defined as ABI <0.9. The primary outcome was bleeding complications within 30 days, which was defined according to the Bleeding Academic Research Consortium classification grade ≥3. The secondary endpoint was all-cause death during follow-up. Results: Of the 824 patients with ACS, 137 (16.6%) exhibited decreased-ABI. The incidence of bleeding complications was significantly higher in patients with decreased-ABI, compared with the remaining patients (21.9% vs. 6.0%, p < 0.001). In multivariate analysis, anemia [odds ratio (OR) 2.14], estimated glomerular filtration rate < 60 mL/min/1.73 m 2 (OR 2.14), femoral access (OR 3.31), use of an intra-aortic balloon pump (OR 3.16), and decreased-ABI (OR 2.58) were independent predictors of 30-day bleeding complications. Assigning 1 point for each variable, we developed a new bleeding risk score (range, 0–5). The area under the receiver-operating characteristic curve for the probability of 30-day bleeding for the new risk score was significantly superior than that of the traditional one (0.82 vs. 0.76, p < 0.05). During the median 4-year follow-up, there were 98 incidents of all-cause death. Multivariate Cox-proportional hazard analysis revealed that decreased-ABI [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.15–3.13, p < 0.05] and 30-day bleeding (HR 3.00, 95% CI 1.76–4.97, p < 0.001) were associated with an increased risk of all-cause mortality. Conclusions: Assessment of ABI provides useful information for predicting 30-day bleeding complications and long-term mortality in patients with ACS after PCI.