Objectives

The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI).

Background

LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated.

Methods

All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months.

Results

Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment.

Conclusions

Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.

中文翻译：

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接受左主动脉疾病 PCI 的患者高出血风险的患病率和影响

目标

本研究的目的是确定学术研究联盟 HBR 标准确定的高出血风险 (HBR) 在接受左主干 (LM) 经皮冠状动脉介入治疗 (PCI) 的真实患者中的患病率和预后影响。

背景

LM PCI 通常用于围手术期不良事件风险增加的患者。HBR 的患者占该队列的相关百分比，但他们在 LM PCI 后的结果仍然没有得到很好的研究。

方法

前瞻性招募了 2014 年至 2017 年间在三级医疗中心接受 LM PCI 的所有患者。如果患者满足至少 1 个主要或 2 个次要学术研究联盟 HBR 标准，则他们被定义为患有 HBR。主要终点是 12 个月时全因死亡、心肌梗死 (MI) 或卒中的复合终点。

结果

在 619 名入组患者中，55.3% 在 HBR。由于全因死亡风险增加，HBR 患者的主要终点发生率是未接受 HBR 患者的 4 倍（20.5% 对 4.9%；HR：4.43；95% CI：2.31-8.48） （HR：3.88；95% CI：1.88-8.02）和 MI（HR：6.18；95% CI：1.83-20.9）。两组的靶血管或病变血运重建率和支架内血栓形成率相当。HBR 患者的出血发生率更高（HR：3.77；95% CI：1.83-7.76）。在 Cox 多变量回归调整后观察到一致的结果。

结论

在接受 LM PCI 的患者中，HBR 患者全因死亡、心肌梗死和出血的风险增加。相反，重复血运重建和支架血栓形成的发生率相当，表明虚弱和合并症是 HBR 患者预后较差的主要原因。