Heart failure symptoms after PCI increase risk of adverse events
Managing heart failure (HF) symptoms after patients undergo percutaneous coronary intervention (PCI) can help reduce their long-term risk of a major adverse cardiac event (MACE), according to new research out of Japan.
The study, published in the International Journal of Cardiology Cardiovascular Risk and Prevention, focused on data from more than 7,000 patients who underwent PCI from April 2014 to March 2020 at one of seven Japanese hospitals.[1] All data came from the Clinical Deep Data Accumulation System database. A three-year follow-up was performed on each patient.
Patients were categorized based on the presence of high brain natriuretic peptide (BNP) levels, a clear sign of HF, and major bleeding events within 30 days of PCI. High BNP was defined as anything more than 100 pg/ml. Fourteen patients had high BNP levels and 30-day bleeding events, 370 patients had high BNP levels without 30-day bleeding events, 74 patients had normal BNP levels and 30-day bleeding events and a clear majority (6,702) of patients had normal BNP levels without 30-day bleeding events.
MACE events—defined as a heart attack, stroke or death—were seen in a total of 388 PCI patients. This included 28.6% of patients with high BNP levels and 30-day bleeding events, 14.9% of patients with high BNP levels without 30-day bleeding events, 8.33% of patients with normal BNP levels and 30-day bleeding events and 4.82% of patients with normal BNP levels without 30-day bleeding events.
Among patients with and without 30-day bleeding events, high BNP levels were associated with a heightened MACE risk and a long-term risk of all-cause death. The risk appeared to be higher for patients with high BNP levels and 30-day bleeding events, but the difference was not statistically significant.
Reviewing these findings, the authors emphasized that closely managing patients in those first 30 days after PCI could make a significant impact on their long-term health.
“We employed a 30-day cut-off because bleeding events within 30 days accounted for a large percentage of the total bleeding events within three years,” wrote first author So Ikebe, with the department of cardiovascular medicine at Kumamoto University in Japan, and colleagues. "These results suggest that appropriate management to prevent bleeding events should be performed immediately after a PCI.”
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