Antithrombotic therapy and prognosis of patients with acute coronary syndrome and high bleeding risk after percutaneous coronary intervention

Wu Yonghui; Yan Yan; Nie Shaoping

doi:10.3760/j.issn.1673-4777.2024.04.001

Abstract：Objective To investigate the antithrombotic therapy and clinical prognosis of acute coronary syndrome(ACS)patients with high bleeding risk(HBR)after percutaneous coronary intervention(PCI).Methods A total of 18 382 ACS patients who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 2022 to June 2023 were enrolled.The patients were divided into HBR group and non-HBR group according to whether they met the definition of HBR Academic Research Consortium.The effects of HBR on drug application and in-hospital outcomes in ACS patients after PCI were observed and analyzed.Results Among the 18 382 patients,there were 1 471 cases(accounting for 8.0％)diagnosed as HBR(HBR group)and 16 911 cases in the non-HBR group.There was no significant difference in the proportion of patients using other drugs except oral anticoagulants at admission between the HBR group and the non-HBR group.In the discharge medication,a higher proportion of patients in the HBR group received clopidogrel and oral anticoagulants[76.89％(1 131/1 471)vs 63.22％(10 691/16 911),5.71％(84/1 471)vs 1.45％(246/16 911)],and a lower proportion received ticagrelor[16.38％(241/1 471)vs 28.45％(4 812/16 911)][the absolute values of standardized mean difference(SMD)between groups＞0.2].The hospitalization times of patients in the HBR group were longer than those in the non-HBR group[4(2,5)d vs 3(2,4)d](the absolute values of SMD between groups＞0.2).Compared with the non-HBR group,the HBR group had a higher proportion of death,bleeding,and recurrent myocardial infarction events,but the absolute values of SMD did not exceed 0.2,which was a small difference.Conclusion HBR can significantly affect the drug application of PCI in ACS patients and lead to poor prognosis.HBR patients should be treated according to the current guidelines,actively evaluate and individualized antithrombotic therapy to improve the prognosis.