TY - JOUR
T1 - Impact of nutritional and inflammation status on long-term bleeding in patients undergoing percutaneous coronary intervention with an oral anticoagulant
AU - Yoshida, Ruka
AU - Ishii, Hideki
AU - Morishima, Itsuro
AU - Tanaka, Akihito
AU - Morita, Yasuhiro
AU - Takagi, Kensuke
AU - Yoshioka, Naoki
AU - Hirayama, Kenshi
AU - Iwakawa, Naoki
AU - Tashiro, Hiroshi
AU - Kojima, Hiroki
AU - Mitsuda, Takayuki
AU - Hitora, Yusuke
AU - Furusawa, Kenji
AU - Tsuboi, Hideyuki
AU - Murohara, Toyoaki
N1 - Funding Information:
This study was supported by a grant from Aichi Kidney Foundation and Grant-in-Aid for Scientific Research (KAKENHI) (No. 1 7 K 0 9 4 9 3) of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and the Japanese Society for the Promotion of Science (JSPA).
Funding Information:
H.I. received lecture fees from Astellas Pharma Inc., Bayer Pharmaceutical Co., Ltd., and MSD K. K. T.M. received lecture fees from Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Pfizer Japan Inc., Sanofi-aventis K. K., and Takeda Pharmaceutical Co., Ltd. T.M. received an unrestricted research grant for the Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-aventis K. K., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd. The other authors have nothing to disclose.
Publisher Copyright:
© 2019 Japan Atherosclerosis Society.
PY - 2019
Y1 - 2019
N2 - Aim: Patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet therapy (APT) are exposed to a serious risk of bleeding. The aim of this study was to clarify the relationship among nutritional and inflammation status and long-term bleeding in patients requiring both OACs and APT after PCI. Methods: We performed PCI in 3,718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OACs and APT. Patients were followed for up to 3 years for bleeding events, defined as the Bleeding Academic Research Consortium (BARC) class ≥ 3 bleeding. We retrospectively evaluated the ability of the Geriatric Nutritional Risk Index (GNRI) and high-sensitivity C-reactive protein (hs-CRP) to detect bleeding events. Results: During a median follow-up of 1,080 days, bleeding events were observed in 53 (17.5%) patients. Bleeding events were associated with a low GNRI (≤ 98) (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.84 – 5.45; p<0.0001) and hs-CRP level ≥ 2.5 mg/L (HR, 2.75; 95% CI, 1.61 – 4.78; p=0.0003). A low GNRI+ high hs-CRP showed a 5.12-fold increase in the incidence of BARC class ≥ 3 bleeding (95% CI, 2.68 – 9.91; p< 0.0001) compared with a normal GNRI+low hs-CRP. The addition of the GNRI and hs-CRP to the PRECISE-DAPT score improved C-statistics from 0.67 to 0.71 and enhanced the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.36, p<0.0001; IDI, 0.066, p<0.0001). Conclusions: The GNRI and hs-CRP were novel predictors of the long-term bleeding risk in patients requiring both OACs and APT after PCI.
AB - Aim: Patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet therapy (APT) are exposed to a serious risk of bleeding. The aim of this study was to clarify the relationship among nutritional and inflammation status and long-term bleeding in patients requiring both OACs and APT after PCI. Methods: We performed PCI in 3,718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OACs and APT. Patients were followed for up to 3 years for bleeding events, defined as the Bleeding Academic Research Consortium (BARC) class ≥ 3 bleeding. We retrospectively evaluated the ability of the Geriatric Nutritional Risk Index (GNRI) and high-sensitivity C-reactive protein (hs-CRP) to detect bleeding events. Results: During a median follow-up of 1,080 days, bleeding events were observed in 53 (17.5%) patients. Bleeding events were associated with a low GNRI (≤ 98) (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.84 – 5.45; p<0.0001) and hs-CRP level ≥ 2.5 mg/L (HR, 2.75; 95% CI, 1.61 – 4.78; p=0.0003). A low GNRI+ high hs-CRP showed a 5.12-fold increase in the incidence of BARC class ≥ 3 bleeding (95% CI, 2.68 – 9.91; p< 0.0001) compared with a normal GNRI+low hs-CRP. The addition of the GNRI and hs-CRP to the PRECISE-DAPT score improved C-statistics from 0.67 to 0.71 and enhanced the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.36, p<0.0001; IDI, 0.066, p<0.0001). Conclusions: The GNRI and hs-CRP were novel predictors of the long-term bleeding risk in patients requiring both OACs and APT after PCI.
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U2 - 10.5551/jat.47654
DO - 10.5551/jat.47654
M3 - Article
C2 - 30584221
AN - SCOPUS:85070876980
VL - 26
SP - 728
EP - 737
JO - Journal of Atherosclerosis and Thrombosis
JF - Journal of Atherosclerosis and Thrombosis
SN - 1340-3478
IS - 8
ER -