The Impact of Timing of Ischemic and Hemorrhagic Events on Mortality After Percutaneous Coronary Intervention: The ADAPT-DES Study

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• 作者：Sorin J. Brener ; MD^a ; ^{sjb9005@nyp.org" class="auth_mail" title="E-mail the corresponding author} ; Ajay J. Kirtane ; MD ; SM^b ; ^c ; Thomas D. Stuckey ; MD^d ; Bernhard Witzenbichler ; MD^e ; Michael J. Rinaldi ; MD^f ; Franz-Josef Neumann ; MD^g ; D. Christopher Metzger ; MD^h ; Timothy D. Henry ; MDⁱ ; ^j ; David A. Cox ; MD^k ; Peter L. Duffy ; MD ; MMM^l ; Ernest L. Mazzaferri Jr. ; MD^m ; Roxana Mehran ; MD^b ; ⁿ ; Rupa Parvataneni ; MS^b ; Bruce R. Brodie ; MD^d ; Gregg W. Stone ; MD^b ; ^c
• 关键词：bleeding ; drug-eluting stent(s) ; ischemia ; percutaneous coronary intervention ; stent thrombosis
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：25 July 2016
• 年：2016
• 卷：9
• 期：14
• 页码：1450-1457
• 全文大小：573 K

文摘

The aim of this study was to understand the impact of the timing of ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) with drug-eluting stents on subsequent mortality.

Background

These events have been strongly associated with subsequent death.

Methods

In the multicenter, prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents) study, patients at 11 clinical sites with successful PCI with drug-eluting stents underwent assessment of platelet function and were followed for 2 years. Events occurring after PCI—definite or probable stent thrombosis (ST), myocardial infarction (MI) not related to ST, and clinically relevant bleeding (CB)—were classified as early (≤30 days), late (31 to 365 days), or very late (>365 days). Mortality within 30 days of each event was estimated by Kaplan-Meier methodology. Cox regression multivariate modeling was used to analyze the relationship between each event (as a time-updated variable) and mortality over the entire study period.

Results

Among 8,582 patients, 1,060 (12.4%) had events—691 (8.1%) had CB, 294 (3.4%) had MI, and 75 (0.9%) had ST—and 7,522 (87.6%) had no events. The highest risk was associated with early ST (38.5% mortality at 30 days after the event), whereas very late MI (7.5%) and late CB (7.3%) were less dangerous. By multivariate analysis, each event was independently predictive of death, with hazard ratios of 2.4, 1.8, and 11.4, respectively (p < 0.0001).

Conclusions

Approximately 1 in 8 patients successfully undergoing PCI with drug-eluting stents had CB, MI, or ST during the ensuing 2 years. These events are associated with an increased hazard of mortality, particularly within the first 30 days following the event, warranting efforts to prevent their occurrence.