Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients. Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry

Jason B. Lindsey, Steven P. Marso, Michael Pencina, Joshua M. Stolker, Kevin F. Kennedy, Charanjit Rihal, Greg Barsness, Robert N. Piana, Steven L. Goldberg, Donald E. Cutlip, Neal S. Kleiman, David J. Cohen

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Objectives: Our aim was to examine the prognostic importance of hemorrhagic and ischemic complications after percutaneous coronary intervention (PCI) in unselected patients. Background: In randomized trials of PCI, major bleeding and periprocedural myocardial infarction (pMI) have been associated with increased mortality. Whether similar associations exist among un-selected PCI patients is unknown. Methods: We used data from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry-a multicenter registry of unselected patients undergoing PCI-to examine the association between both in-hospital bleeding and pMI and 1-year mortality. Cardiac enzyme levels were assessed in all patients, and pMI was defined as a peak creatine kinase-MB value ≥3× the upper limit of normal. Post-PCI bleeding was classified by Thrombolysis In Myocardial Infarction criteria. Results: After excluding patients with elevated pre-PCI creatine kinase-MB values and ST-segment elevation myocardial infarction at presentation (n = 1,626), a total of 5,961 patients were available for evaluation. Rates of post-PCI bleeding and pMI were 3.0% and 7.1%, respectively; 1-year all-cause mortality was 2.8%. After multivariable adjustment, both post-PCI bleeding (adjusted hazard ratio [HR]: 3.83, 95% confidence interval: 2.48 to 5.90, p < 0.001) and pMI (adjusted HR: 1.84, 95% confidence interval: 1.17 to 2.89, p = 0.009) were independently associated with 1-year mortality. Time period-specific analyses demonstrated that the adjusted HR for bleeding was similar for 30-day mortality and mortality between 1 month and 1 year, while the adjusted HR for pMI was greater for 30-day mortality as compared with mortality between 1 month and 1 year. Conclusions: Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted.

Original languageEnglish (US)
Pages (from-to)1074-1082
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume2
Issue number11
DOIs
StatePublished - Nov 2009

Fingerprint

Drug-Eluting Stents
Percutaneous Coronary Intervention
Registries
Myocardial Infarction
Hemorrhage
Mortality
Confidence Intervals
MB Form Creatine Kinase
Creatine Kinase
Demography

Keywords

  • bleeding
  • mortality
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients. Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry. / Lindsey, Jason B.; Marso, Steven P.; Pencina, Michael; Stolker, Joshua M.; Kennedy, Kevin F.; Rihal, Charanjit; Barsness, Greg; Piana, Robert N.; Goldberg, Steven L.; Cutlip, Donald E.; Kleiman, Neal S.; Cohen, David J.

In: JACC: Cardiovascular Interventions, Vol. 2, No. 11, 11.2009, p. 1074-1082.

Research output: Contribution to journalArticle

Lindsey, Jason B. ; Marso, Steven P. ; Pencina, Michael ; Stolker, Joshua M. ; Kennedy, Kevin F. ; Rihal, Charanjit ; Barsness, Greg ; Piana, Robert N. ; Goldberg, Steven L. ; Cutlip, Donald E. ; Kleiman, Neal S. ; Cohen, David J. / Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients. Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry. In: JACC: Cardiovascular Interventions. 2009 ; Vol. 2, No. 11. pp. 1074-1082.
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abstract = "Objectives: Our aim was to examine the prognostic importance of hemorrhagic and ischemic complications after percutaneous coronary intervention (PCI) in unselected patients. Background: In randomized trials of PCI, major bleeding and periprocedural myocardial infarction (pMI) have been associated with increased mortality. Whether similar associations exist among un-selected PCI patients is unknown. Methods: We used data from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry-a multicenter registry of unselected patients undergoing PCI-to examine the association between both in-hospital bleeding and pMI and 1-year mortality. Cardiac enzyme levels were assessed in all patients, and pMI was defined as a peak creatine kinase-MB value ≥3× the upper limit of normal. Post-PCI bleeding was classified by Thrombolysis In Myocardial Infarction criteria. Results: After excluding patients with elevated pre-PCI creatine kinase-MB values and ST-segment elevation myocardial infarction at presentation (n = 1,626), a total of 5,961 patients were available for evaluation. Rates of post-PCI bleeding and pMI were 3.0{\%} and 7.1{\%}, respectively; 1-year all-cause mortality was 2.8{\%}. After multivariable adjustment, both post-PCI bleeding (adjusted hazard ratio [HR]: 3.83, 95{\%} confidence interval: 2.48 to 5.90, p < 0.001) and pMI (adjusted HR: 1.84, 95{\%} confidence interval: 1.17 to 2.89, p = 0.009) were independently associated with 1-year mortality. Time period-specific analyses demonstrated that the adjusted HR for bleeding was similar for 30-day mortality and mortality between 1 month and 1 year, while the adjusted HR for pMI was greater for 30-day mortality as compared with mortality between 1 month and 1 year. Conclusions: Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted.",
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T1 - Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients. Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry

AU - Lindsey, Jason B.

AU - Marso, Steven P.

AU - Pencina, Michael

AU - Stolker, Joshua M.

AU - Kennedy, Kevin F.

AU - Rihal, Charanjit

AU - Barsness, Greg

AU - Piana, Robert N.

AU - Goldberg, Steven L.

AU - Cutlip, Donald E.

AU - Kleiman, Neal S.

AU - Cohen, David J.

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N2 - Objectives: Our aim was to examine the prognostic importance of hemorrhagic and ischemic complications after percutaneous coronary intervention (PCI) in unselected patients. Background: In randomized trials of PCI, major bleeding and periprocedural myocardial infarction (pMI) have been associated with increased mortality. Whether similar associations exist among un-selected PCI patients is unknown. Methods: We used data from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry-a multicenter registry of unselected patients undergoing PCI-to examine the association between both in-hospital bleeding and pMI and 1-year mortality. Cardiac enzyme levels were assessed in all patients, and pMI was defined as a peak creatine kinase-MB value ≥3× the upper limit of normal. Post-PCI bleeding was classified by Thrombolysis In Myocardial Infarction criteria. Results: After excluding patients with elevated pre-PCI creatine kinase-MB values and ST-segment elevation myocardial infarction at presentation (n = 1,626), a total of 5,961 patients were available for evaluation. Rates of post-PCI bleeding and pMI were 3.0% and 7.1%, respectively; 1-year all-cause mortality was 2.8%. After multivariable adjustment, both post-PCI bleeding (adjusted hazard ratio [HR]: 3.83, 95% confidence interval: 2.48 to 5.90, p < 0.001) and pMI (adjusted HR: 1.84, 95% confidence interval: 1.17 to 2.89, p = 0.009) were independently associated with 1-year mortality. Time period-specific analyses demonstrated that the adjusted HR for bleeding was similar for 30-day mortality and mortality between 1 month and 1 year, while the adjusted HR for pMI was greater for 30-day mortality as compared with mortality between 1 month and 1 year. Conclusions: Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted.

AB - Objectives: Our aim was to examine the prognostic importance of hemorrhagic and ischemic complications after percutaneous coronary intervention (PCI) in unselected patients. Background: In randomized trials of PCI, major bleeding and periprocedural myocardial infarction (pMI) have been associated with increased mortality. Whether similar associations exist among un-selected PCI patients is unknown. Methods: We used data from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry-a multicenter registry of unselected patients undergoing PCI-to examine the association between both in-hospital bleeding and pMI and 1-year mortality. Cardiac enzyme levels were assessed in all patients, and pMI was defined as a peak creatine kinase-MB value ≥3× the upper limit of normal. Post-PCI bleeding was classified by Thrombolysis In Myocardial Infarction criteria. Results: After excluding patients with elevated pre-PCI creatine kinase-MB values and ST-segment elevation myocardial infarction at presentation (n = 1,626), a total of 5,961 patients were available for evaluation. Rates of post-PCI bleeding and pMI were 3.0% and 7.1%, respectively; 1-year all-cause mortality was 2.8%. After multivariable adjustment, both post-PCI bleeding (adjusted hazard ratio [HR]: 3.83, 95% confidence interval: 2.48 to 5.90, p < 0.001) and pMI (adjusted HR: 1.84, 95% confidence interval: 1.17 to 2.89, p = 0.009) were independently associated with 1-year mortality. Time period-specific analyses demonstrated that the adjusted HR for bleeding was similar for 30-day mortality and mortality between 1 month and 1 year, while the adjusted HR for pMI was greater for 30-day mortality as compared with mortality between 1 month and 1 year. Conclusions: Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted.

KW - bleeding

KW - mortality

KW - myocardial infarction

KW - percutaneous coronary intervention

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