Prediction of thrombotic and bleeding events after percutaneous coronary intervention

CREDO-Kyoto thrombotic and bleeding risk scores

On behalf of the CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET, NEXT trial investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background--Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. Methods and Results--We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting Versus Xience/Promus Everolimus-Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3-year incidence of thrombotic events than a score that was intermediate (2-3, n=1178) or low (0-1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P < 0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1-2, n=1802) or low (0, n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P < 0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk, whereas 401 (58.8%) had high bleeding risk with very high incidence of bleeding (11.6%). Conclusions--CREDO-Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.

Original languageEnglish
Article numbere008708
JournalJournal of the American Heart Association
Volume7
Issue number11
DOIs
Publication statusPublished - 01-06-2018

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Percutaneous Coronary Intervention
Outcome Assessment (Health Care)
Hemorrhage
Thrombosis
Stents
Peripheral Vascular Diseases
Chronic Renal Insufficiency
Atrial Fibrillation
Incidence
Heart Failure
Myocardial Infarction
Streptokinase
Tissue Plasminogen Activator
Sirolimus
Area Under Curve
Registries
Anemia
Coronary Vessels
Diabetes Mellitus
Stroke

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

On behalf of the CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET ; NEXT trial investigators. / Prediction of thrombotic and bleeding events after percutaneous coronary intervention : CREDO-Kyoto thrombotic and bleeding risk scores. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 11.
@article{cd6102dcceca46d6a73f9814e8eeec02,
title = "Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores",
abstract = "Background--Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. Methods and Results--We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting Versus Xience/Promus Everolimus-Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3-year incidence of thrombotic events than a score that was intermediate (2-3, n=1178) or low (0-1, n=2809) (7.6{\%}, 3.7{\%}, versus 2.4{\%}, respectively; P < 0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1-2, n=1802) or low (0, n=2201) (8.8{\%}, 4.1{\%}, versus 2.3{\%}, respectively; P < 0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7{\%}) had low bleeding risk, whereas 401 (58.8{\%}) had high bleeding risk with very high incidence of bleeding (11.6{\%}). Conclusions--CREDO-Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.",
author = "{On behalf of the CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET} and {NEXT trial investigators} and Masahiro Natsuaki and Takeshi Morimoto and Kyohei Yamaji and Hirotoshi Watanabe and Yusuke Yoshikawa and Hiroki Shiomi and Yoshihisa Nakagawa and Yutaka Furukawa and Kazushige Kadota and Kenji Ando and Takashi Akasaka and Hanaoka, {Keiichi Igarashi} and Ken Kozuma and Kengo Tanabe and Yoshihiro Morino and Toshiya Muramatsu and Takeshi Kimura and Mitsuo Matsuda and Hirokazu Mitsuoka and Hisayoshi Fujiwara and Yoshiki Takatsu and Ryoji Taniguchi and Ryuji Nohara and Tomoyuki Murakami and Teruki Takeda and Masakiyo Nobuyoshi and Masashi Iwabuchi and Ryozo Tatami and Manabu Shirotani and Toru Kita and Natsuhiko Ehara and Hiroshi Kato and Hiroshi Eizawa and Katsuhisa Ishii and Masaru Tanaka and Lee, {Jong Dae} and Akira Nakano and Akinori Takizawa and Masaaki Takahashi and Minoru Horie and Hiroyuki Takashima and Takashi Tamura and Mamoru Takahashi and Chuwa Tei and Shuichi Hamasaki and Hirofumi Kambara and Osamu Doi and Satoshi Kaburagi and Kazuaki Mitsudo and Yukio Ozaki",
year = "2018",
month = "6",
day = "1",
doi = "10.1161/JAHA.118.008708",
language = "English",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "11",

}

Prediction of thrombotic and bleeding events after percutaneous coronary intervention : CREDO-Kyoto thrombotic and bleeding risk scores. / On behalf of the CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET; NEXT trial investigators.

In: Journal of the American Heart Association, Vol. 7, No. 11, e008708, 01.06.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of thrombotic and bleeding events after percutaneous coronary intervention

T2 - CREDO-Kyoto thrombotic and bleeding risk scores

AU - On behalf of the CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET

AU - NEXT trial investigators

AU - Natsuaki, Masahiro

AU - Morimoto, Takeshi

AU - Yamaji, Kyohei

AU - Watanabe, Hirotoshi

AU - Yoshikawa, Yusuke

AU - Shiomi, Hiroki

AU - Nakagawa, Yoshihisa

AU - Furukawa, Yutaka

AU - Kadota, Kazushige

AU - Ando, Kenji

AU - Akasaka, Takashi

AU - Hanaoka, Keiichi Igarashi

AU - Kozuma, Ken

AU - Tanabe, Kengo

AU - Morino, Yoshihiro

AU - Muramatsu, Toshiya

AU - Kimura, Takeshi

AU - Matsuda, Mitsuo

AU - Mitsuoka, Hirokazu

AU - Fujiwara, Hisayoshi

AU - Takatsu, Yoshiki

AU - Taniguchi, Ryoji

AU - Nohara, Ryuji

AU - Murakami, Tomoyuki

AU - Takeda, Teruki

AU - Nobuyoshi, Masakiyo

AU - Iwabuchi, Masashi

AU - Tatami, Ryozo

AU - Shirotani, Manabu

AU - Kita, Toru

AU - Ehara, Natsuhiko

AU - Kato, Hiroshi

AU - Eizawa, Hiroshi

AU - Ishii, Katsuhisa

AU - Tanaka, Masaru

AU - Lee, Jong Dae

AU - Nakano, Akira

AU - Takizawa, Akinori

AU - Takahashi, Masaaki

AU - Horie, Minoru

AU - Takashima, Hiroyuki

AU - Tamura, Takashi

AU - Takahashi, Mamoru

AU - Tei, Chuwa

AU - Hamasaki, Shuichi

AU - Kambara, Hirofumi

AU - Doi, Osamu

AU - Kaburagi, Satoshi

AU - Mitsudo, Kazuaki

AU - Ozaki, Yukio

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background--Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. Methods and Results--We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting Versus Xience/Promus Everolimus-Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3-year incidence of thrombotic events than a score that was intermediate (2-3, n=1178) or low (0-1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P < 0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1-2, n=1802) or low (0, n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P < 0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk, whereas 401 (58.8%) had high bleeding risk with very high incidence of bleeding (11.6%). Conclusions--CREDO-Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.

AB - Background--Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. Methods and Results--We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting Versus Xience/Promus Everolimus-Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3-year incidence of thrombotic events than a score that was intermediate (2-3, n=1178) or low (0-1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P < 0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1-2, n=1802) or low (0, n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P < 0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk, whereas 401 (58.8%) had high bleeding risk with very high incidence of bleeding (11.6%). Conclusions--CREDO-Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.

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U2 - 10.1161/JAHA.118.008708

DO - 10.1161/JAHA.118.008708

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - e008708

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