Bleeding complications after percutaneous coronary intervention in patients with acute coronary syndrome
Yan Yan
Wang Xiao
Fan Jingyao
Nie Shaoping
Song Xiantao
Sergio Raposeiras-Roubín
Emad Abu-Assi
José Paulo Simao Henriques
Fabrizio D'Ascenzo
Jorge Saucedo
José Ramon González-Juanatey
Stephen B.Wilton
Wouter J.Kikkert
Iván Nu(n)ez-Gil
Albert Ariza-Sole
Dimitrios Alexopoulos
Christoph Liebetrau
Testuma Kawaji
Claudio Moretti
Zenon Huczek
Toshiharu Fujii
Luis Claudio Correia
Masa-aki Kawashiri
Sasko Kedev
Abstract：Objective To analyze the occurrence of bleeding complications after percutaneous coronary intervention(PCI) in patients with acute coronary syndrome(ACS).Methods Totally 18 077 patients with ACS who had PCI from January 2003 to December 2014 in 16 chnical centers from 11 countries were retrospectively analyzed;558 patients had bleeding complications (bleeding group)and 17 519 cases without bleeding were included in non-bleeding group.Clinical features,operative notes and biochemical indicators were analyzed.Results Totally 15 401 cases in 15 centers from 10 countries were finally included(2 676 cases from Macedonia center were excluded due to lack of key variables);12 910 cases had complete follow-up data;bleeding events occurred in 409 cases;gastrointestinal tract bleeding accounted for 48.7％ (199/409) and intracranial bleeding accounted for 7.6％ (31/409).Multivariate logistic regression analysis showed that previous bleeding history and hypertension history are risk factors of 1 year gastrointestinal tract bleeding.Based on Cox regession model and propensity score,9 429 cases were included for stratified analysis.After discharge,4 126 patients had clopidogrel and 4 814 patients had clopidogrel combined with proton pump inhibitors (PPI);138 patients had ticagrelor and 351 patients had ticagrelor combined with PPI.Kaplan-Meier analysis showed that the 1 year incidence of bleeding in clopidogrel combined with PPI group was significantly higher than that in clopidogrel group(P =0.004);there was no significant difference of incidence of bleeding between ticagrelor combined with PPI group and ticagrelor group (P =0.573).Conclusion The most common bleeding complication is gastrointestinal bleeding in ACS patient after PCI;ticagrelor combined with PPI is reasonable for patients with high risk of gastrointestinal bleeding.
Keywords：Acute coronary syndromeHemorrhageProton pump inhibitorsClopidogrelTicagrelor
Publication Date：2017-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 801-805 )