Study Examines Association of Spontaneous Bleeding and MI With Long-Term Mortality After PCI

April 6, 2015—In the Journal of the American College of Cardiology (JACC), Dhruv S. Kazi, MD, et al published findings from a study that sought to examine, in a real-world cohort, the association between spontaneous major bleeding or myocardial infarction (MI) after percutaneous coronary intervention (PCI) and long-term mortality (2015;65:1411–1420).

The study showed that spontaneous bleeding after a PCI was independently associated with higher long-term mortality and conveyed a risk comparable to that of an MI during follow-up. This tradeoff between efficacy and safety bolsters the argument for personalizing antiplatelet therapy after PCI on the basis of the patient’s long-term risk of both thrombotic and bleeding events, concluded the investigators in JACC.

The background of the study is that although MIs and bleeds during the index hospitalization for PCI are known to negatively affect long-term outcomes, the impact of spontaneous bleeding occurring after discharge on long-term mortality is unknown.

As summarized in JACC, the investigator conducted a retrospective cohort study of patients age ≥ 30 years who underwent a PCI between 1996 and 2008 in an integrated health care delivery system. An extended Cox regression was used to examine the associations of spontaneous bleeding and MI with all-cause mortality, after adjustment for time-updated demographics, comorbidities, periprocedural events, and longitudinal medication exposure.

Among 32,906 patients who had a PCI and survived the index hospitalization, 530 had bleeds and 991 had MIs between 7 and 365 days after discharge. There were 4,048 deaths over a mean follow-up of 4.42 years. The crude annual death rate after a spontaneous bleed (9.5%) or MI (7.6%) was higher than among patients who experienced neither event (2.6%). Bleeding was associated with an increased rate of death, similar to that after an MI. The association of bleeding with death remained significant after additional adjustment for the longitudinal use of antiplatelet agents, reported the investigators in JACC.