Background: The patterns of late major bleeding (MB) after percutaneous coronary intervention (PCI) remained unknown in Chinese patients.

Objective: To determine the incidence, prediction, and long-term outcomes of late MB in Chinese patients.

Method: This was a retrospective cohort study from 14 hospitals in Hong Kong. Participants were patients undergoing first-time PCI without MB within 30 days or death within 1 year. Patients were stratified by the presence of late MB, defined as MB between 30 to 365 days. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac events (MACE).

Results: A total of 32,057 patients were analysed. After adjustment for baseline characteristics, peri-procedural characteristics and medications on discharge, the risks of all-cause mortality at 5 years were significantly higher with late MB (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.92 to 2.41; P<0.001). Late MB was also associated with a higher risk of MACE (HR, 1.57; 95% CI 1.03 to 1.50; P<0.001), myocardial infarction (HR, 1.25; 95% CI, 1.04 to 1.52; P=0.02) and stroke (HR, 1.38; 95% CI, 1.09 to 1.73; P=0.006). The CARDIAC score had a good discriminating power for prediction of MB within 365 days (area under receiver operator curve 0.76).

Conclusions: Late MB was independently associated with a higher risk of mortality, MACE, myocardial infarction and stroke in patients undergoing PCI. The CARDIAC score is a simple model that can predict MB after PCI. Prevention of MB represents as an important strategy to optimize cardiovascular outcomes for patients undergoing PCI.


JACC: Asia Editor-in-Chief   
Jian’an Wang, MD, PhD, FACC  
  
CME Editor   
Kenneth A. Ellenbogen, MD  

Authors 
Andrew Kei-Yan Ng, MBBS
Pauline Yeung Ng, MBBS
April Ip, MPH
Ian Wood-Hay Ling, MBBS
Lap-Tin Lam, MBBS
Chung-Wah Siu, MD

Important Dates 

Date of Release: June 21, 2022  
Term of Approval/Date of CME/MOC/ECME Expiration: June 20, 2023