Louis Giovachini, Paul Guedeney, Michel Zeitouni, Stéphanie Rouanet, Johanne Silvain, Niki Procopi, Guillaume Cayla, Benjamin Honton, Thibault Lhermussier, Géraldine Gibault Genty, Sebastien Hess, Ludovic Meunier, François Tarragano, Gauthier Mouillet, Pascal Motreff, Stephan Chassaing, Eric Van Belle, Matthieu Godin, Farzin Beygui, Christophe Caussin, Philippe Commeau, Hakim Benamer, Jacques Monsegu, Etienne Puymirat, Gregoire Rangé, Gilles Montalescot
After PCI there is an incremental risk of death with ischemic, bleeding and the combination of ischemic and bleeding complications occurring during hospitalization. Bleeding complications late after discharge seem to bear a higher risk of death than ischemic complications.
BACKGROUND: The link to mortality and respective weight of ischemic events, hemorrhagic events or both after percutaneous coronary interventions (PCI) remain unclear, especially in regards of the time of occurrence.
OBJECTIVES: To compare the association between ischemic and bleeding complications and mortality according to the timing of their occurrence after PCI.
METHODS: All patients included in the FRANCE PCI registry between 2014 and 2020 were categorized, according to the occurrence of an ischemic complication (stent thrombosis, myocardial infarction, stroke or unplanned revascularization), a major bleeding (BARC type≥3), both or none of these complications. The analysis was also performed according to the timing of the complication (in-hospital or within one year of PCI). The primary outcome was all-cause mortality, analyzed 1/ during the index hospitalization for PCI by multivariable logistic regression, and 2/ over different periods of time after discharge from the index hospitalization, with a piecewise Cox multivariable model using ischemic and hemorrhagic complications as time-dependent variables.
RESULTS: A total of 54,599 patients were included (75% male, median age 69 years), with an acute PCI in 52.9% of the cases. During hospitalization, ischemic complications (aOR 8.4, 95% CI 6.4-10.9), bleeding complications (aOR 10.3, 95% CI 8.1-13.2), and their combination (aOR 13.2, 95% CI 7.0-24.7) were all associated with increased mortality. After discharge, both ischemic and bleeding complications remained significantly associated with all-cause mortality although the strength of these associations decreased over time. Late (beyond 24 weeks) bleeding complications were more strongly associated with mortality (aHR 6.0 95%CI:5.0-7.3) than late ischemic complications (aHR 2.5 95%CI:2.0-3.1).
CONCLUSIONS: After PCI there is an incremental risk of death with ischemic, bleeding and the combination of ischemic and bleeding complications occurring during hospitalization. Bleeding complications late after discharge seem to bear a higher risk of death than ischemic complications.