Gastrointestinal and Intracranial Bleeding Events After Second-Generation Drug-Eluting Stent Implantation　― Their Association With High Bleeding Risk, Predictors, and Clinical Outcomes

• Published in: Circulation Journal Vol. 86; no. 5; pp. 775 - 783
• Main Authors: Taguchi, Yuya, Miura, Katsuya, Shima, Yuki, Okabe, Koya, Ikuta, Akihiro, Takahashi, Kotaro, Osakada, Kohei, Takamatsu, Makoto, Ohya, Masanobu, Shimada, Takenobu, Kubo, Shunsuke, Tada, Takeshi, Tanaka, Hiroyuki, Fuku, Yasushi, Kadota, Kazushige
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.04.2022
• Subjects: Drug-Eluting Stents - adverse effects; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - epidemiology; High bleeding risk; Humans; Intracranial bleeding; Intracranial Hemorrhages; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Platelet Aggregation Inhibitors; Risk Factors; Second-generation drug-eluting stent; Treatment Outcome; Intracranial bleeding; Second-generation drug-eluting stent; Percutaneous coronary intervention; Gastrointestinal bleeding; High bleeding risk
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-21-0620

Background: Gastrointestinal bleeding (GIB) and intracranial bleeding (ICB) are frequently observed as major bleeding events after percutaneous coronary intervention (PCI); however, there are few reports on these predictors and their association with the Academic Research Consortium for High Bleeding Risk (ARC-HBR).Methods and Results: The study included 3,453 patients who underwent PCI with second-generation drug-eluting stents between 2010 and 2013. Mean follow up was 2,663±596 days. The cumulative incidences of GIB and ICB were significantly higher in the HBR group than in the non-HBR group (6.3% vs. 1.9%, P<0.001, 5.5% vs. 2.3%, P<0.001). Older age, oral anticoagulant (OAC), and severe chronic kidney disease were independent predictors of GIB (hazard ratios [HR], 1.64; 95% confidence intervals [CI], 1.11–2.41; P=0.012; HR, 1.94; 95% CI, 1.23–3.05; P=0.004; HR, 1.80; 95% CI, 1.02–3.19, P=0.043 respectively), and low body weight, OAC, and left main coronary artery stenting were independent predictors of ICB by multivariate logistic regression analysis (HR, 1.83; 95% CI, 1.20–2.80; P=0.005; HR, 2.04; 95% CI, 1.31–3.19; P=0.002; HR, 1.79; 95% CI, 1.18–2.70; P=0.006 respectively).Conclusions: ARC-HBR was consistently associated with GIB and ICB within a 7-year period. GIB and ICB had three predictors each. Of these, only OAC administration was common, and the other two were different.