Predicting long-term bleeding after percutaneous coronary intervention

Praneet K. Sharma, Adnan K. Chhatriwalla, David J. Cohen, Jae Sik Jang, Paramdeep Baweja, Kensey Gosch, Philip Jones, Richard G. Bach, Suzanne V. Arnold, John A. Spertus

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objectives: To construct a model to predict long-term bleeding events following percutaneous coronary intervention (PCI). Background: Treatment with dual antiplatelet therapy following PCI involves balancing the benefits of preventing ischemic events with the risks of bleeding. There are no models to predict long-term bleeding events after PCI. Methods: We analyzed 1-year bleeding outcomes from 3,128 PCI procedures in the Patient Risk Information Services Manager (PRISM) observational study. Patient-reported bleeding events were categorized according to Bleeding Academic Research Consortium (BARC) definitions. Logistic regression analysis was used to develop a model predicting BARC ≥ 1 bleeding. Results: BARC 0, 1, 2 or 3 bleeding was observed in 574 (18.4%); 2382 (76.2%); 114 (3.6%); and 58 (1.8%) patients, respectively. Compared to patients who had no bleeding, patients with BARC ≥ 1 bleeding were more often female (30 vs. 23%), Caucasian (94 vs. 83%), had a higher incidence of drug eluting stent (DES) implantation (83 vs. 76%) and warfarin therapy (7.4 vs. 3.9%), and a lower incidence of diabetes (31 vs. 45%; P-value <0.01 for all comparisons). A 27-variable model had moderate discrimination (c-statistic of 0.674), and good calibration, as did a parsimonious model with 10 variables (c-statistic = 0.667). This model performed well in predicting BARC ≥ 2 bleeding events as well (c-statistic = 0.653). Conclusions: Bleeding is common in the first year after PCI, and can be predicted by pre-procedural patient characteristics and use of DES. Objective estimates of bleeding risk may help support shared decision-making with respect to stent selection and duration of antiplatelet therapy following PCI.

Original languageEnglish
Pages (from-to)199-206
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume89
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

  • PCI
  • antiplatelet therapy
  • bleeding
  • drug eluting stent

Fingerprint Dive into the research topics of 'Predicting long-term bleeding after percutaneous coronary intervention'. Together they form a unique fingerprint.

  • Cite this

    Sharma, P. K., Chhatriwalla, A. K., Cohen, D. J., Jang, J. S., Baweja, P., Gosch, K., Jones, P., Bach, R. G., Arnold, S. V., & Spertus, J. A. (2017). Predicting long-term bleeding after percutaneous coronary intervention. Catheterization and Cardiovascular Interventions, 89(2), 199-206. https://doi.org/10.1002/ccd.26529