Female sex as an independent predictor of high bleeding risk among East Asian percutaneous coronary intervention patients: A sex difference analysis

Kodaira, Masaki; Sawano, Mitsuaki; Tanaka, Makoto; Kuno, Toshiki; Numasawa, Yohei; Ueda, Ikuko; Fukuda, Keiichi; Kohsaka, Shun

doi:10.1016/j.jjcc.2021.05.016

Cited by 7 publications

(2 citation statements)

References 59 publications

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“…But this study defined the major bleeding as overt bleeding with hemoglobin decreasing >3 g/dl or >4 g/dl with no overt source of bleeding. Kodaira et al also showed that women has a higher risk of bleeding in 2,494 acute coronary syndrome (ACS) patients undergoing PCI (29). The bleeding events of this study occurred in patients after discharge and not all bleeding events were more common in women such as the hemorrhagic stroke (26.6 vs. 29.6%).…”

Section: Discussionmentioning

confidence: 48%

Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention

Chen

Liu

Zhou

et al. 2022

Front. Cardiovasc. Med.

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BackgroundWhether women have a higher risk of adverse events compared with men following coronary angiography (CAG) and percutaneous coronary intervention (PCI) remains controversial. We aimed to investigate the sex differences in characteristics, treatments and outcomes among patients undergoing CAG and PCI in a large Chinese cohort.MethodsWe analyzed patients undergoing CAG and/or PCI in this multi-center registry cohort study Cardiorenal ImprovemeNt II (CIN-II) in 5 Chinese tertiary hospitals from 2007 to 2020. Clinical characteristics, treatment (discharge medication and PCI) and in-hospital outcomes (mortality and major bleeding) were compared between women and men.ResultsTotally 141,459 patients underwent CAG (44,362 [31.4%] women), of which 69,345 patients underwent PCI (15,376 [22.2%] women). Women were older (64.4 vs. 60.8 years), had more chronic comorbidities and lower PCI rate for stable coronary artery disease (CAD) than men (52.8 vs. 64.2%). Women received less CAG and PCI procedures. Among women undergoing PCI they received similar discharge medication treatment. In addition, women undergoing PCI had mildly lower rate of major bleeding (0.2 vs. 0.3%, P = 0.033) but higher in-hospital mortality (1.2 vs. 0.8%, P < 0.001). After adjustment, women had a higher risk in the major bleeding (adjusted odds ratio, 2.04 [95% CI: 1.07 to 3.62]), and the in-hospital mortality (adjusted odds ratio, 1.87 [95% CI: 1.36 to 2.56]).ConclusionAmong our Chinese cohort, women are older with more chronic comorbidities, receiving less PCI procedure and similar discharge medication treatment. Women have nearly 90% higher risk of in-hospital mortality and over 1-fold increased risk of major bleeding after PCI compared with men.

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Section: Discussionmentioning

confidence: 48%

Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention

Chen

Liu

Zhou

et al. 2022

Front. Cardiovasc. Med.

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“…In addition to abdominal congestion that causes early satiety and nausea, chronic inflammation and consequent metabolic disturbance induce malnutrition and cachexia, making a vicious cycle 30 . Other characteristics of the low GNRI group that were associated with bleeding events included age, 31–33 female sex, 34,35 lower levels of haemoglobin, 32,36 and lower levels of estimated glomerular filtration rate 32,37 …”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index predicts bleeding event in patients with heart failure

Sato,

Yoshihisa,

Nozaki

et al. 2023

ESC Heart Failure

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AimsWe aimed to elucidate the association between malnutrition and the occurrence of bleeding events in patients with heart failure.Methods and resultsWe evaluated the nutritional status of patients with heart failure [n = 2044, median (inter‐quartile range) age 69.0 (59.0–78.0) years, 1209 (59.1%) males] using the Geriatric Nutritional Risk Index (GNRI). The primary endpoint was a composite of bleeding events such as haemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut‐off point of GNRI for predicting the primary endpoint was 106.2. We divided the patients into two groups based on GNRI levels: high GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and low GNRI group (GNRI < 106.2, n = 1438, 70.4%). We compared the patients' characteristics and prognosis between the two groups. The low GNRI group was older [72.0 (63.0–79.0) vs. 63.0 (53.0–73.0) years, P < 0.001] and had a lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001). There were no differences in the use of antiplatelet agents and anticoagulants between the two groups. Levels of B‐type natriuretic peptide were higher [321.1 (123.3–667.4) vs. 111.6 (42.6–235.4) pg/mL, P < 0.001] and levels of haemoglobin were lower [12.4 (10.8–13.7) vs. 14.2 (12.9–15.4) g/dL, P < 0.001] in the low GNRI group. The Kaplan–Meier analysis demonstrated that bleeding event rates were higher in the low GNRI group (log‐rank P < 0.001). The multivariable Cox proportional hazard analysis revealed that low GNRI (hazard ratio 1.952, 95% confidence interval 1.002–3.805, P = 0.049) was associated with bleeding events.ConclusionsHeart failure patients with poor nutritional status, determined by GNRI under 106.2, experienced high bleeding event rates. Comprehensive management is required to avoid bleeding event in those populations.

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Gender Differences in Long-Term Outcomes of Young Patients Who Underwent Percutaneous Coronary Intervention: Long-Term Outcome Analysis from a Multicenter Registry in Japan

Kuno,

Miyamoto,

Sawano

et al. 2023

The American Journal of Cardiology

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Female sex as an independent predictor of high bleeding risk among East Asian percutaneous coronary intervention patients: A sex difference analysis

Cited by 7 publications

References 59 publications

Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention

Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention

Geriatric Nutritional Risk Index predicts bleeding event in patients with heart failure

Gender Differences in Long-Term Outcomes of Young Patients Who Underwent Percutaneous Coronary Intervention: Long-Term Outcome Analysis from a Multicenter Registry in Japan

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