Balancing Long-Term Risks of Ischemic and Bleeding Complications After Percutaneous Coronary Intervention With Drug-Eluting Stents

• Published in: The American journal of cardiology 2015-09, Vol.116 (5), p.686-693
• Main Authors: Matteau, Alexis, MD, MSc, Yeh, Robert W., MD, MSc, Camenzind, Edoardo, MD, Steg, P. Gabriel, MD, Wijns, William, MD, Mills, Joseph, MD, Gershlick, Anthony, MD, de Belder, Mark, MD, Ducrocq, Gregory, MD, Mauri, Laura, MD, MSc
• Format: Article
• Language: English
• Subjects: Aged; Blood Transfusion - methods; Cardiology; Cardiovascular; Clinical outcomes; Coronary Artery Disease - surgery; Dose-Response Relationship, Drug; Drug-Eluting Stents - adverse effects; Europe - epidemiology; Female; Follow-Up Studies; Heart attacks; Humans; Immunosuppressive Agents - pharmacology; Incidence; Male; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Myocardial Infarction - prevention & control; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Prognosis; Retrospective Studies; Sirolimus - analogs & derivatives; Sirolimus - pharmacology; Stents; Survival Rate - trends; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.05.036

Although trials comparing antiplatelet strategies after percutaneous coronary intervention report average risks of bleeding and ischemia in a population, there is limited information to guide choices based on individual patient risks, particularly beyond 1 year after treatment. Patient-level data from Patient Related Outcomes With Endeavor vs Cypher Stenting Trial (PROTECT), a broadly inclusive trial enrolling 8,709 subjects treated with drug-eluting stents (sirolimus vs zotarolimus-eluting stent), and PROTECT US, a single-arm study including 1,018 subjects treated with a zotarolimus-eluting stent, were combined. The risk of ischemic events, cardiovascular death/non-periprocedural myocardial infarction (MI)/definite or probable stent thrombosis, and bleeding events, Global Use of Strategies to Open Occluded Arteries moderate or severe bleed, were predicted using logistic regression. At median follow-up of 4.1 years, major bleeding occurred in 260 subjects (2.8%) and ischemic events in 595 (6.3%). Multivariate predictors of bleeding were older age, smoking, diabetes mellitus, congestive heart failure, and chronic kidney disease (all p