Impact of Bleeding on Quality of Life in Patients on DAPT: Insights From TRANSLATE-ACS

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• 作者：Amit P. Amin ; MD ; MSc^&lowast ; ; ^&dagger ; ; Tracy Y. Wang ; MD ; MHS ; MS^&Dagger ; ; Lisa McCoy ; MS^&Dagger ; ; Richard G. Bach ; MD^&lowast ; ; ^&dagger ; ; Mark B. Effron ; MD^&Dagger ; ; Eric D. Peterson ; MD ; MPH^§ ; ; David J. Cohen ; MD ; MSc^‖ ; ^¶ ; ; ^{dcohen@saint-lukes.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：antiplatelet therapy ; bleeding ; percutaneous coronary intervention ; quality of life
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：5-12 January 2016
• 年：2016
• 卷：67
• 期：1
• 页码：59-65
• 全文大小：416 K

文摘

Prolonged dual antiplatelet therapy (DAPT) is recommended after an acute myocardial infarction (AMI) to reduce ischemic events but is associated with increased rates of major and minor bleeding.

bsSec_2">Objectives

bspara0015">This study sought to determine the incidence of post-percutaneous coronary intervention (PCI) bleeding that occurs on contemporary DAPT and its impact on quality of life (QOL).

bsSec_3">Methods

bspara0020">We studied 9,290 AMI patients treated with PCI and discharged alive between April 2010 and September 2012. Post-discharge bleeding was categorized according to the Bleeding Academic Research Consortium (BARC) definition. The primary outcome was the 6-month Euro QOL–5 Dimension (EQ-5D) index score (a measure of health utility); a secondary outcome was the EQ-5D visual analog scale (VAS) at 6 months.

bsSec_4">Results

bspara0025">Of the 9,290 patients with AMI, bleeding events occurred as follows: any BARC bleeding: 24.2%; BARC 1: 9.1%; BARC 2: 13.8%; BARC 3: 1.1%; BARC 4: 0.03%; and BARC 5: 0%. Those who experienced any BARC bleeding had lower scores across all 5 EQ-5D domains (mobility, self-care, usual activities, pain, and anxiety), as well as lower EQ-5D VAS and EQ-5D index scores. After clinical risk adjustment, any BARC bleeding was independently associated with 6-month EQ-5D index score (p < 0.0001) and lower QOL (p < 0.001). Both the EQ-5D index and the VAS score declined in a stepwise fashion with increasing BARC severity.

bsSec_5">Conclusions

bspara0030">Among patients undergoing PCI for AMI, bleeding during follow-up was associated with worse 6-month utility and QOL. Although even minor bleeding was associated with impaired health status and QOL, the degree of impairment increased in a stepwise fashion with bleeding severity.