How a high bleeding risk impacts outcomes for left main PCI patients
Patients undergoing left main percutaneous coronary intervention (LM PCI) who are at a high bleeding risk (HBR) face an elevated risk of poor outcomes, according to new data published in JACC: Vascular Interventions.
The study included 619 patients with left main coronary artery disease (LM CAD) who underwent PCI from 2014 and 2017. Data came from the institutional catheterization laboratory database at Mount Sinai Hospital in New York.
The median patient age was 75 years old, and 58.2% were men. More than 55% of patients met the Academic Research Consortium definition of HBR.
The study's primary endpoint was the composite of all-cause death, MI, or stroke at 12 months. This endpoint was seen in 20.5% of HBR patients and just 4.9% of other patients.
The group found that this was driven primarily by an elevated rate of all-cause death and MI.
At the same time, there were no differences between the two groups regarding target vessel or lesion revascularization. Also, the rate of definite or probable stent thrombosis was low and similar between the two patient groups.
Another key finding from the team’s analysis was that most bleeding events took place during hospitalization in both groups, with a notably higher rate of in-hospital bleeding in HBR patients.
The authors observed consistent findings after removing age from the variables included in the multivariable Cox regression model.
“To the best of our knowledge, this is the largest study specifically evaluating outcomes after LM PCI in patients at HBR,” wrote lead author Mauro Chiarito, MD, with the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and colleagues.
“Patients presenting with LM CAD who do not undergo revascularization have a dramatically increased risk for death because of the large amount of myocardium at risk, estimated to be more than 80% in patients with right coronary dominance," wrote lead author Mauro Chiarito, MD, a specialist at Icahn School of Medicine at Mount Sinai in New York, and colleagues. "Moreover, its epidemiologic relevance is notable, being reported in almost 5% to 10% of patients undergoing coronary angiography."
Chiarito et al. also noted that the optimal management of LM CAD calls for a careful evaluation and a tailored approach to each patient.
Read the full study here.