Impact of prior stroke on bleeding after percutaneous coronary intervention

  • Natsuaki M & al.
  • J Am Heart Assoc
  • 19 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • The risk for intracranial haemorrhage (ICH) and ischaemic events, but not for non‐intracranial bleeding after percutaneous coronary intervention (PCI) was higher in patients with prior haemorrhagic or ischaemic stroke as compared with those with no-prior stroke.

Why this matters

  • At present, there are limited data evaluating the bleeding risk of patients with prior haemorrhagic and ischaemic stroke separately.

Study design

  • Patient‐level pooled analysis of the 3 Japanese PCI studies (n=19475; CREDO-Kyoto, RESET and NEXT)
  • The effect of prior haemorrhagic (n=285) or ischemic stroke (n=1773) relative to no‐prior stroke (n=17417) on ischemic and bleeding outcomes after PCI was assessed.
  • Funding: Pharmaceuticals and Medical Devices Agency in Tokyo, Japan; and others.

Key results

  • Prior haemorrhagic and ischaemic stroke groups vs those in the no-prior stroke group had higher cumulative incidence of:
    • ICH (6.8%, 2.5% and 1.3%; P<.0001>
    • non-intracranial bleeding (8.8%, 8.0% and 6.0%; P=.001),
    • gastrointestinal bleeding (3.7%, 3.0% and 2.2%; P=.04),
    • GUSTO moderate/severe bleeding (15.1%, 10.3% and 7.1%; P<.0001>
    • primary ischaemic end point of ischaemic stroke/MI (12.7%, 13.4% and 7.5%; P<.0001>
    • ischaemic stroke (7.1%, 7.7% and 2.6%; P<.0001 and>
    • all-cause death (14.7%, 17.1% and 9.0%; P<.0001 respectively>
  • The risks of both prior haemorrhagic and ischaemic strokes relative to no-prior stroke remained significant for ICH (HR, 4.44; 95% CI, 2.64-7.01; P<.0001 and hr ci p=".02)," but not for non-intracranial bleeding respectively>
  • The risks of both prior haemorrhagic and ischaemic strokes relative to no-prior stroke remained significant for ischaemic events mainly driven by the higher risk for ischaemic stroke (HR, 1.46; 95% CI, 1.02-2.01; P=.04, and HR, 1.49; 95% CI, 1.29-1.72; P<.0001 respectively>

Limitations

  • Risk of residual cofounding.