- NEWS . 30 Dec 2019
Ischaemia and bleeding occur at similar rates within a year after PCI in unselected ACS patients
The risk of recurrent ischaemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) occurred at similar rates within 1 year of PCI. The average daily ischaemic risk (ADIR) was greater than the average daily bleeding risk (ADBR) in the first 2 weeks, especially in ST-segment elevation myocardial infarction (STEMI) patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.
The data were derived from almost 20,000 patients with ACS treated with PCI and clopidogrel, prasugrel or ticagrelor, and were collected in two multicentre registries: BleeMACS and RENAMI. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (p=0.886). In the first 2 weeks, ADIR was higher than ADBR (p=0.013), especially in patients with STEMI or incomplete revascularization.
ADIR continued to be (non-significantly) greater than ADBR up to the third month, whereas ADBR became higher (non-significantly) afterwards. Patients with incomplete revascularization had an excess in ischaemic risk (p=0.003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (p=0.012 and p=0.022, respectively).
D'Ascenzo F, et al. Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries. Am Heart J 2019;220:108-115.