The Impact of Timing of Ischemic and Hemorrhagic Events on Mortality After Percutaneous Coronary Intervention: The ADAPT-DES Study

Sorin J. Brener, Ajay J. Kirtane, Thomas D. Stuckey, Bernhard Witzenbichler, Michael J. Rinaldi, Franz Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Roxana Mehran, Rupa Parvataneni, Bruce R. Brodie, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objectives The aim of this study was to understand the impact of the timing of ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) with drug-eluting stents on subsequent mortality. Background These events have been strongly associated with subsequent death. Methods In the multicenter, prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents) study, patients at 11 clinical sites with successful PCI with drug-eluting stents underwent assessment of platelet function and were followed for 2 years. Events occurring after PCI—definite or probable stent thrombosis (ST), myocardial infarction (MI) not related to ST, and clinically relevant bleeding (CB)—were classified as early (≤30 days), late (31 to 365 days), or very late (>365 days). Mortality within 30 days of each event was estimated by Kaplan-Meier methodology. Cox regression multivariate modeling was used to analyze the relationship between each event (as a time-updated variable) and mortality over the entire study period. Results Among 8,582 patients, 1,060 (12.4%) had events—691 (8.1%) had CB, 294 (3.4%) had MI, and 75 (0.9%) had ST—and 7,522 (87.6%) had no events. The highest risk was associated with early ST (38.5% mortality at 30 days after the event), whereas very late MI (7.5%) and late CB (7.3%) were less dangerous. By multivariate analysis, each event was independently predictive of death, with hazard ratios of 2.4, 1.8, and 11.4, respectively (p < 0.0001). Conclusions Approximately 1 in 8 patients successfully undergoing PCI with drug-eluting stents had CB, MI, or ST during the ensuing 2 years. These events are associated with an increased hazard of mortality, particularly within the first 30 days following the event, warranting efforts to prevent their occurrence.

Original languageEnglish (US)
Pages (from-to)1450-1457
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume9
Issue number14
DOIs
StatePublished - Jul 1 2016

Bibliographical note

Publisher Copyright:
© 2016 American College of Cardiology Foundation

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • bleeding
  • drug-eluting stent(s)
  • ischemia
  • percutaneous coronary intervention
  • stent thrombosis

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