Prediction of risk for bleeding, myocardial infarction and mortality after percutaneous coronary intervention in patients with acute coronary syndromes

Gjin Ndrepepa, Franz Josef Neumann, Maurizio Menichelli, Gert Richardt, Salvatore Cassese, Erion Xhepa, Sebastian Kufner, Shqipdona Lahu, Alp Aytekin, Hendrik B. Sager, Michael Joner, Tareq Ibrahim, Arne Müller, Massimiliano Fusaro, Alexander Hapfelmeier, Karl Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati, Markus Kasel

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background Whether bleeding and myocardial infarction (MI) improve the performance of risk prediction models for mortality in patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) remains unknown. Methods This study included 3377 patients with ACS who underwent PCI in the setting of the ISAR-REACT 5 trial. Patients with bleeding, MI or those dying at 1 year after PCI were characterized in terms of baseline characteristics, risk estimates and C-statistic of the risk prediction models for these outcomes. Results Major bleeding (Bleeding Academic Research Consortium types 3-5), MI and mortality occurred in 195 patients (5.8%), 143 patients (4.3%) and 143 patients (4.3%), respectively. After adjustment, bleeding [hazard ratio = 5.08; 95% confidence interval (CI), 3.03-8.53; P < 0.001] and MI [hazard ratio = 5.90; 95% CI, (3.00-11.65); P < 0.001) remained independently associated with the risk for 1-year mortality. The C-statistic (with 95% CI) of the model for bleeding, MI and mortality was, 0.755 (0.722-0.786), 0.752 (0.717-0.789) and 0.868 (0.837-0.896), respectively. The inclusion of bleeding [C-statistic: 0.892 (0.867-0.913); delta C-statistic 0.024 (-0.014 to 0.065); P = 0.200] or MI [C-statistic: 0.878 (0.851-0.903); delta C-statistic 0.011 (-0.030 to 0.053); P = 0.635] in the risk prediction models for mortality alongside baseline demographical and clinical variables did not improve prediction for mortality. Conclusions In patients with ACS treated with PCI, mortality is the most accurately predicted outcome. Bleeding and MI did not improve risk discrimination for mortality when added in the risk prediction models for mortality suggesting that these outcomes do not provide incremental prognostic information on top of baseline demographical and clinical data.

Original languageEnglish
Pages (from-to)213-221
Number of pages9
JournalCoronary Artery Disease
Volume33
Issue number3
DOIs
StatePublished - 1 May 2022

Keywords

  • acute coronary syndrome
  • bleeding
  • mortality
  • myocardial infarction
  • percutaneous coronary intervention

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