Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS

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• 作者：Usman Baber ; MD ; MS^a ; Roxana Mehran ; MD^a ; ^{roxana.mehran@mountsinai.org" class="auth_mail" title="E-mail the corresponding author} ; Gennaro Giustino ; MD^a ; David J. Cohen ; MD ; MSc^b ; Timothy D. Henry ; MD^c ; Samantha Sartori ; PhD^a ; Cono Ariti ; MSc^d ; Claire Litherland ; MS^e ; George Dangas ; MD ; PhD^a ; C. Michael Gibson ; MD^f ; Mitchell W. Krucoff ; MD^g ; David J. Moliterno ; MD^h ; Ajay J. Kirtane ; MD ; SM^e ; ⁱ ; Gregg W. Stone ; MD^e ; ⁱ ; Antonio Colombo ; MD^j ; Alaide Chieffo ; MD^j ; Annapoorna S. Kini ; MD^a ; Bernhard Witzenbichler ; MD^k ; Giora Weisz ; MD^l ; Philippe Gabriel Steg ; MD^m ; Stuart Pocock ; PhD^d
• 关键词：bleeding ; PCI ; risk ; thrombosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：17 May 2016
• 年：2016
• 卷：67
• 期：19
• 页码：2224-2234
• 全文大小：891 K

文摘

Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking.

Objectives

The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after percutaneous coronary intervention with drug-eluting stents.

Methods

Using data from 4,190 patients treated with drug-eluting stents and enrolled in the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) registry, separate risk scores were developed to predict CTE (defined as the composite of stent thrombosis or myocardial infarction) and MB (defined as the occurrence of a Bleeding Academic Research Consortium type 3 or 5 bleed). External validation was performed in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) registry.

Results

Over 2 years, CTEs occurred in 151 patients (3.8%) and MB in 133 (3.3%). Independent predictors of CTEs included acute coronary syndrome, prior revascularization, diabetes mellitus, renal dysfunction, and current smoking. Independent predictors of MB included older age, body mass index, triple therapy at discharge, anemia, current smoking, and renal dysfunction. Each model displayed moderate levels of discrimination and adequate calibration.

Conclusions

Simple risk scores of baseline clinical variables may be useful to predict risks for ischemic and bleeding events after PCI with DES, thereby facilitating clinical decisions surrounding the optimal duration of DAPT. (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients [PARIS]; NCT00998127)