Prognostic and Practical Validation of ESC/EACTS High Ischemic Risk Definition on Long-Term Thrombotic and Bleeding Events in Contemporary PCI Patients

Abstract

The ESC/EACTS myocardial revascularization guidelines recently standardized the definition of patients at high ischemic risk (HIR). However, the ability of ESC/EACTS-HIR criteria to stratify ischemic and bleeding risk in a contemporary real-world East Asian cohort remains unexplored. Methods: A total of 10,167 consecutive patients undergoing PCI from prospective Fuwai PCI Registry (January 2013 to December 2013) were reviewed. ESC/EACTS-HIR features was defined as having at least one of the eight clinical and angiographic characteristics. The primary ischemic endpoint was target vessel failure (cardiac death, target vessel myocardial infarction [MI], or target vessel revascularization [TVR]); bleeding outcome was assessed using the BARC type 2, 3, or 5 bleeding. Median follow-up was 29 months. Results: Compared with non-HIR patients, HIR patients (n 5,149, 50.6%) were associated with increased risk for target vessel failure (adjusted hazard ratio [HRadjust]: 1.48 [1.25-1.74]) and patient-oriented composite outcome (HRadjust: 1.44 [1.28-1.63]), as well as cardiac death, MI, and TVR. By contrast, the risk of clinically relevant bleeding was not significantly different between the two groups. (HRadjust: 0.84 [0.66-1.06]). Greater than or equal to three implanted stents and diabetic patients with diffuse multivessel coronary disease emerged as independent predictors for long-term adverse outcomes. There was no significant interaction between high bleeding risk (HBR) status and clinical outcomes associated with ESC/EACTS-HIR criteria (all Pinteraction 0.05). Conclusion:The ESC/EACTS-HIR features identified patients at increased risk of thrombotic events, including cardiac death, but not for clinically relevant bleeding. Importantly, HBR did not modify cardiovascular risk subsequent to patients with ESC/EACTS-HIR features, suggesting its potential clinical applicability in tailoring antithrombotic therapy. and the advent of newer drugs and devices have allowed expanding the use of percutaneous coronary intervention (PCI) to several complex clinical IntroductionAdvances in interventional cardiology techniques

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“…The present study was a prospective, observational cohort study at Fuwai hospital, Chinese Academy of Medical Sciences [ 17 ]. From January 2013 to December 2013, a total of 10,724 patients who underwent PCI at Fuwai hospital were consecutively screened.…”

Tailoring Antithrombotic Regimens for Percutaneous Coronary Intervention Patients with High Bleeding and Ischemic Risk (TAILOR-BIRISK): Individualized Management and Genotype-Guided De-escalation

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Establishing the optimal duration of DAPT following PCI in high‐risk TWILIGHT‐like patients with acute coronary syndrome

“…PCI was performed according to standard techniques. 18 The access sites for PCI, the size and length of implanted stents, the use of intravascular ultrasound and glycoprotein IIb/IIIa inhibitors were determined by operators. Before PCI, loading doses of aspirin (300 mg) and P2Y12 inhibitor (clopidogrel 300 or 600 mg or ticagrelor 180 mg) were administered.…”