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

研究成果: ジャーナルへの寄稿学術論文査読

13 被引用数 (Scopus)

抄録

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.

本文言語英語
ページ(範囲)728-737
ページ数10
ジャーナルJournal of atherosclerosis and thrombosis
26
8
DOI
出版ステータス出版済み - 2019

All Science Journal Classification (ASJC) codes

  • 内科学
  • 循環器および心血管医学
  • 生化学、医学

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