Impact of nutritional and inflammation status on long-term bleeding in patients undergoing percutaneous coronary intervention with an oral anticoagulant

Ruka Yoshida, Hideki Ishii, Itsuro Morishima, Akihito Tanaka, Yasuhiro Morita, Kensuke Takagi, Naoki Yoshioka, Kenshi Hirayama, Naoki Iwakawa, Hiroshi Tashiro, Hiroki Kojima, Takayuki Mitsuda, Yusuke Hitora, Kenji Furusawa, Hideyuki Tsuboi, Toyoaki Murohara

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3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)728-737
Number of pages10
JournalJournal of atherosclerosis and thrombosis
Volume26
Issue number8
DOIs
Publication statusPublished - 01-01-2019
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Biochemistry, medical

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    Yoshida, R., Ishii, H., Morishima, I., Tanaka, A., Morita, Y., Takagi, K., Yoshioka, N., Hirayama, K., Iwakawa, N., Tashiro, H., Kojima, H., Mitsuda, T., Hitora, Y., Furusawa, K., Tsuboi, H., & Murohara, T. (2019). Impact of nutritional and inflammation status on long-term bleeding in patients undergoing percutaneous coronary intervention with an oral anticoagulant. Journal of atherosclerosis and thrombosis, 26(8), 728-737. https://doi.org/10.5551/jat.47654