A patient’s risk for ischemic events, but not bleeding, after percutaneous coronary intervention (PCI) can be predicted simply based on if they have one or more guideline-based standardized hazard criteria, a large-scale real analysis suggests.
Haoyu Wang, MD, and colleagues showed that having at least one insecure feature, as summarized at the 2018 European Society of Cardiology and European Association for Cardiothoracic Surgery (ESC/EACTS) Guidelines on Myocardial Revascularization, was associated with a heightened risk for target vessel failure by 48percent and for a patient-oriented composite outcome by 44%. )
Moreover, they demonstrated that implantation of at least three stents and the existence of diabetes and diffuse multivessel disease were the only high-risk attributes from the guidelines which were independent predictors of both outcomes.
The analysis of more than 10,000 PCI patients additionally showed that determining whether patients were in high bleeding risk (HBR) did not alter their ischemic hazard.
This, said Wang, from the National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, underscores the importance of applying the elevated ischemic risk (HIR) standards from the ESC/EACTS guidelines when assigning double antiplatelet treatment (DAPT).
Wang advised theheart.org | Medscape Cardiology they conducted the study to determine which — HIR or HBR — is”most important to balance when treating patients undergoing PCI and then having dual antiplatelet therapy.”
The results demonstrated that when patients have both a HIR and HBR, it’s the ESC/EACTS guideline HIR criteria that have”a higher impact” than the bleeding risk, which this can be”used to guide our choice of the duration of dual anti-platelet therapy.”
“Maybe we can extend, or use more potent, P2Y12 inhibitors” in those circumstances, he explained.
S. Lale Tokgözoğlu, MD, PhD, professor of cardiology, Hacettepe University, Ankara, Turkey, who was not involved in the study, said the HIR assessment”performed well,” adding the HBR score could have been expected to attenuate its”prognostic advantage.”
She told theheart.org | Medscape Cardiology that the results”are interesting since previous observations have suggested that Asian patients may be more prone to medication side effects and bleeding.”
These findings emphasize the importance of assessing HIR in daily PCI practice and affirm it”performs well in different populations in real life,” added Tokgözoğlu, a former president of the EAS.
The ESC/EACTS guidelines aimed to standardize the definition of HIR, Wang said during the demonstration.
They place out 10 risky attributes for ischemic events for patients undergoing revascularization, which included patient health history, comorbid conditions, as well as the characteristics of the PCI procedure.
Although the goals of the criteria are to notify decision-making and stimulate research, Wang said that their”prevalence and prognostic association with clinical outcomes are yet to be established in real-world PCI practice.”
Alongside, the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score was created to forecast out-of-hospital bleeding in patients getting DAPT following stent implantation.
Although a PRECISE-DAPT score of at least 25 constitutes a patient in high bleeding risk, Wang pointed out that such patients are generally also at risk for ischemic events after PCI, and it’s”unclear” whether being at HBR modifies this risk.
To investigate further, they used the prospective, real-world Fuwai PCI registry to collate an all-comer patient people using unselected utilization of drug-eluting stents at the National Center for Cardiovascular Diseases at Fuwai Hospital.
They excluded individuals who had been treated with balloon angioplasty alone, bioresorbable scaffolds, or bare metal stents, leaving a total population of 10,167 patients that were treated in 2013.
In that cohort, 5149 sufferers (50.6%) fulfilled at least one risk criterion from the ESC/EACTS guidelines (HIR patients) and 5018 (49.4%) fulfilled none of the hazard standards (non-HIR patients).
The most common criteria were implantation of at lea