Author + information
- Sabato Sorrentino1,
- Usman Baber2,
- Jaya Chandrasekhar1,
- Serdar Farhan1,
- Zhen Ge1,
- Birgit Vogel1,
- Samantha Sartori1,
- Jason Kovacic3,
- Pedro Moreno3,
- Javed Suleman4,
- Pooja Vijay1,
- Clayton Snyder1,
- Madhav Sharma1,
- Hannah Levine1,
- Gennaro Giustino1,
- Annapoorna Kini5,
- Samin Sharma5 and
- Roxana Mehran2
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 2Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 3Mount Sinai Medical Center, New York, New York, United States
- 4Mount Sinai Hospital, New York, New York, United States
- 5Mount Sinai Health System, New York, New York, United States
Introduction: There are limited data on the uptake of guideline directed medical therapy (GDMT) and the specific impact of high bleeding risk (HBR) on ischemic outcomes following PCI. Aim of this study is to evaluate the rate of GDMT use and 1 year outcomes in an all comer population undergoing percutaneous coronary intervention (PCI), using the previously validated PARIS bleeding risk score.
all the patients undergoing PCI in our center were divided in low, intermediate and high bleeding risk (HBR) groups using the PARIS bleeding Risk score. GDMT was defined as a combination of dual antiplatelet therapy, statin, β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in patients with an ACC/AHA class I indication for each medication. Target vessel/lesion revascularization, myocardial infarction and death were evaluated at 1 year.
During the study period, 3,443 patients presented high risk bleeding profile, while the low and intermediate risk populations were 5,729 and 7,717, respectively. HBR patients were older with higher prevalence of female gender, hypertension, peripheral arterial disease, chronic kidney disease, prior PCI and cerebrovascular events. After adjusting for different baseline characteristics HBR patients experienced higher rates of mortality (aHR 5.0; CI: 3.158-7.94; p<0.001) and myocardial infarction (aHR 2.97; CI: 1.74-5.04; p<0.001). Despite this excess risk, use of GDMT and potent P2Y12 inhibitors was lower in the HBR patients compared with intermediate and low risk groups (Figure).
In contemporary clinical practice, patients classified as HBR also experience very high rates of ischemic events and are much less likely to receive GDT that may modulate such risk compared to patients at lower bleeding risk.
CORONARY: Angioplasty Overview and Outcomes