Author + information
- Sang Yeub Lee1,
- Rebecca Torguson2,
- Hector M. Garcia-Garcia3,
- Gilbert Tang4,
- Toby Rogers5,
- Sarkis Kiramijyan6,
- Edward Koifman7,
- Smita I. Negi8,
- Jiaxiang Gai9,
- Lowell Satler2,
- Augusto Pichard2 and
- Ron Waksman10
- 1MedStar Washington Hospital Center, North Bethesda, Maryland, United States
- 2Washington Hospital Center, Washington, District of Columbia, United States
- 3Medstar Washington Hospital, Washington, D.C., United States
- 4Westchester Medical Center
- 5Complejo Hospitalario de Huelva, Huelva, Spainn
- 6Division of Cardiology, Department of Medicine and Clinical Scie
- 7MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 8Toda Central General Hospital
- 9University of Verona, Verona, Italy
- 10Medstar Heart Institute, Washington, District of Columbia, United States
Patients undergoing percutaneous coronary intervention (PCI) with Drug eluting stents (DES) are subject to prolonged dual antiplatelet therapy (DAPT) which can lead to increase in bleeding rate in high bleed risk (HBR) population. Patients with HBR are often treated with bare metallic stents (BMS). The aim of this study is to examine the effect of HBR on the likelihood of receiving a drug-eluting stent (DES).
Patients undergoing PCI in the DES era (April 2003 to September 2015) were retrospectively analyzed. Patients presenting with shock were excluded. Standard practice was followed for patients receiving DES or no DES for discharge DAPT therapy. HBR is defined as patients who required to meet one or more of the high bleeding risk criteria of LEADERS FREE trial: age >=75, warfarin use at discharge, prior history of stroke, cancer in previous 3 years, glucocorticoid use at discharge, or baseline laboratory values of hemoglobin (Hgb) < 11g/liter, platelet count <100,000/mm3 or creatinine clearance(CCr) < 40 ml/min. The type of stent was recorded in all patients. Multivariable logistic regression was performed with respect to receiving at least 1 DES during PCI.
In this period, 25,441 patients who underwent PCI, 10,594 (41.6%) met HBR definition. The most frequent HBR criteria were: age >75 years in 5723 (54.0%), CCr < 40 ml/min in 2507 (23.7%), prior stroke in 1951 (18.4%), and Hgb in <11 g/liter 1885 (17.8%). Some patients had one or more HBR criteria: One HBR criterion 6626 (62.5%), two 2761 (26.1%) and three 2761 (8.98%). In the multivariable logistic regression the OR for HBR patients to receive at least one DES was 0.58 [0.54, 0.62], p <0.001 when adjusted for known risk factors (Figure1). Within the HBR group alone, patients with 3 or more HBR criteria were less likely treated with DES than patients with one or two risk factors (OR 0.50 [0.44,0.57], p <0.001).
Given the era of extended DAPT duration post PCI for secondary prevention and the finding that the likelihood to receive DES drops with the increase in HBR risk factor count, the optimal treatment of patients with at least one HBR risk factor needs to be further explored.
CORONARY: Stents: Drug-Eluting