Outcomes of Everolimus-Eluting Stents in Patients at High Bl
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What are the long-term outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with a drug (everolimus)-eluting stent?

Compared to the non-HBR population, HBR patients experienced worse 4-year outcomes after PCI with the cobalt-chromium everolimus-eluting stent.

Both coronary thrombotic events and MB had a significant impact on subsequent risk of mortality irrespective of bleeding risk.

Data on 10,502 patients were analyzed from four all-comers post-approval international registries. Patients with at least one of the following criteria were categorized as HBR: age ≥75 years, history of major bleeding (MB), history of stroke, chronic oral anticoagulant use, chronic kidney disease (CKD), anemia, or thrombocytopenia, and 3,507 (33%) were identified as HBR.

During 4-year follow-up, HBR patients had more comorbidities, higher lesion complexity, and a higher risk of 4-year mortality. Anemia, CKD, age ≥75 years, prior myocardial infarction (MI), and diabetes mellitus were the most significant predictors of all-cause death in HBR patients, whereas in non-HBR patients, they were current smoking, diabetes mellitus, and prior MI. Risk of mortality was increased after a chronic thrombotic event, as well as after any major bleeding in the entire cohort irrespective of baseline bleeding risk.

Occurrence of major bleeding or ischemic event predispose all patients post-PCI to a higher subsequent mortality risk irrespective of DAPT duration. These results highlight the need for aggressive secondary prevention in such patients post-PCI. Further research targeting novel therapies such as PCSK9 inhibitors in this patient population will help identify other approaches to tackle this elevated long-term hazard in such patients.

Source: https://www.acc.org/latest-in-cardiology/journal-scans/2020/02/06/14/42/long-term-safety-and-efficacy-of-durable