Stent Thrombosis and Bleeding After PCI With DES

Study Questions:

What are the predictors of stent thrombosis and bleeding in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES)?

Methods:

The authors used data from 4,190 patients enrolled in the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) registry to develop models to predict risk of bleeding and coronary thrombotic events (composite of stent thrombosis and myocardial infarction). This model was then validated in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) registry.

Results:

A coronary thrombotic event occurred in 3.8% of patients, while a major bleeding occurred in 3.3% of patients on follow-up. Independent predictors of a coronary thrombotic event included acute coronary syndrome, prior revascularization, diabetes mellitus, renal dysfunction, and current smoking. Major bleeding was predicted by age, triple therapy, body mass index, anemia, current smoking, and renal dysfunction. The models had moderate discrimination in the validation cohort (c statistic 0.65 for thrombotic and 0.65 for the bleeding risk score).

Conclusions:

Simple risk scores can be used to predict the long-term risk of bleeding and thrombosis in patients undergoing PCI with DES.

Perspective:

There has been considerable interest in predicting long-term risk of thrombosis and bleeding in patients undergoing DES-based PCI and using that to guide duration of dual antiplatelet therapy. The models that have been developed have demonstrated poor discrimination, and their value for individualized decision making is marginal at best (also see Yeh RW, et al., JAMA 2016;315:1735-49). It would be premature to adopt these models for clinical practice without further research.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Interventions and ACS, Smoking

Keywords: Acute Coronary Syndrome, Anemia, Blood Platelets, Body Mass Index, Coronary Thrombosis, Diabetes Mellitus, Drug-Eluting Stents, Myocardial Infarction, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Renal Insufficiency, Risk Assessment, Smoking


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