AI Article Synopsis

  • - The study assessed the occurrence and predictors of major bleeding in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) and were treated with prasugrel or ticagrelor.
  • - Out of 4424 patients, 1.8% experienced significant bleeding after about 14 months, which was linked to higher rates of major adverse cardiovascular events (MACE) and death.
  • - Older adults (over 75 years) and women were identified as independent risk factors for major bleeding, suggesting a need for personalized antiplatelet therapy strategies in these groups.

Article Abstract

Objectives: To evaluate "real life" incidence and independent predictors of major bleeding defined in ACS patients treated with PCI and current standard antithrombotic therapy with prasugrel or ticagrelor.

Methods And Results: The RENAMI project is a multicenter retrospective observational registry enrolling 4424 patients with ACS treated with PCI and prasugrel or ticagrelor plus aspirin. Primary endpoint was MACE (major adverse cardiovascular events). Secondary endpoints included each component of MACE, cardiovascular death (CV death), recurrence of ACS (reACS) and stroke. Eighty three (1.8%) patients developed out of hospital major bleedings after 14.1 ± 6.2 months. These patients had higher rates of MACE (14.5% vs 4.4%; p = 0.001) and of all-cause death (11% vs 2.1%; p < 0.001). Independent predictors of major bleeding were age >75 years (OR 2.00; 95% CI 1.18-3.41; p = 0.010) and female sex (OR 1.66; 95% CI 1.02-2.70; p = 0.041). BARC 3-5 bleeding was independently associated with all-cause mortality (OR 3.46; 95% CI 1.64-7.31; p 0.001).

Conclusion: In ACS patients treated with PCI and ticagrelor or prasugrel, BARC 3-5 bleedings despite being uncommon negatively impacted on prognosis. Old and female patients are at increased risk, offering clinical indications for tailoring dual antiplatelet therapy.

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Source
http://dx.doi.org/10.1016/j.ijcard.2018.09.020DOI Listing

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