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. 2023 Jun 25:18:200193.
doi: 10.1016/j.ijcrp.2023.200193. eCollection 2023 Sep.

Impact of heart failure severity and major bleeding events after percutaneous coronary intervention on subsequent major adverse cardiac events

So Ikebe  1 , Masanobu Ishii  1 , Yasuhiro Otsuka  1 , Taishi Nakamura  1   2 , Kenichi Tsujita  1 , Tetsuya Matoba  3 , Takahide Kohro  4 , Yusuke Oba  5 , Tomoyuki Kabutoya  5 , Yasushi Imai  6 , Kazuomi Kario  5 , Arihiro Kiyosue  7 , Yoshiko Mizuno  7   8 , Kotaro Nochioka  9 , Masaharu Nakayama  10 , Takamasa Iwai  11 , Yoshihiro Miyamoto  12 , Hisahiko Sato  13 , Naoyuki Akashi  14 , Hideo Fujita  14 , Ryozo Nagai  15 ; CLIDAS research group
Affiliations

Impact of heart failure severity and major bleeding events after percutaneous coronary intervention on subsequent major adverse cardiac events

So Ikebe et al. Int J Cardiol Cardiovasc Risk Prev. .

Erratum in

Abstract

Background: Heart failure (HF) is associated with a high bleeding risk after percutaneous coronary intervention (PCI). Additionally, major bleeding events increase the risk of subsequent major adverse cardiac events (MACE). However, whether brain natriuretic peptide (BNP) levels and major bleeding events following PCI are associated with MACE and all-cause death remains unknown. This study aimed to investigate the impact of HF severity or bleeding on subsequent MACE and all-cause death.

Methods: The Clinical Deep Data Accumulation System (CLIDAS), a multicenter database involving seven hospitals in Japan, was developed to collect data from electronic medical records. This retrospective analysis included 7160 patients who underwent PCI between April 2014 and March 2020 and completed a three-year follow-up. Patients were divided according to the presence of HF with high BNP (HFhBNP) (>100 pg/ml) and major bleeding events within 30 days post-PCI (30-day bleeding): HFhBNP with bleeding (n = 14), HFhBNP without bleeding (n = 370), non-HFhBNP with bleeding (n = 74), and non-HFhBNP without bleeding (n = 6702).

Results: In patients without 30-day bleeding, HFhBNP was a risk factor for MACE (hazard ratio, 2.19; 95% confidence interval, 1.56-3.07) and all-cause death (hazard ratio, 1.60; 95% confidence interval, 1.60-2.23). Among HFhBNP patients, MACE incidence was higher in patients with 30-day bleeding than in those without bleeding, but the difference was not significant (p = 0.075). The incidence of all-cause death was higher in patients with bleeding (p = 0.001).

Conclusions: HF with high BNP and bleeding events in the early stage after PCI might be associated with subsequent MACE and all-cause death.

Keywords: Acute coronary syndrome; Bleeding; Heart failure; High BNP; Major adverse cardiac event; Percutaneous coronary intervention.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Study flowchart. Patients were divided into four groups according to the presence of heart failure (HF) with high BNP levels (HFhBNP) (>100 pg/ml) and major bleeding events within 30 days after PCI. HF, heart failure; BNP, brain natriuretic peptide; PCI, percutaneous coronary intervention.
Fig. 2
Fig. 2
Major adverse cardiac event (MACE) rates of the four groups between 30 days and three years. Kaplan-Meier survival curves show the rate of MACE in PCI patients stratified by HF with high BNP levels (>100 pg/ml) and 30-day bleeding. P-values were calculated using the log-rank test. MACE, major adverse cardiac events; HF, heart failure; BNP, brain natriuretic peptide; PCI, percutaneous coronary intervention.
Fig. 3
Fig. 3
Cox proportional hazard regression for MACE and all-cause death between 30 days and three years. *Adjusted for age, sex, body mass index, systolic blood pressure at admission, acute coronary syndrome or chronic coronary syndrome, hypertension, diabetes, dyslipidemia, chronic kidney disease, hemodialysis, previous PCI, previous coronary artery bypass grafting, prior MI, prior stroke, prior AF, prior PAD, LMT, MVD, anticoagulants, DAPT, and PPI. †Complete case analysis (n = 5330, 74.4%). ** A multiple imputation analysis was performed with 20 imputed datasets generated by the fully conditional specification method. The results across the 20 imputed datasets were combined using Rubin's rules. HR, hazard ratio, CI; confidence interval; HF, heart failure; BNP, brain natriuretic peptide; PCI, percutaneous coronary intervention; AF, atrial fibrillation; MVD, mitral valve disease; PAD, peripheral artery disease LMT, left main coronary trunk; DAPT, dual antiplatelet therapy; PPI, proton pump inhibitor.
Fig. 4
Fig. 4
All-cause death rates of the four groups between 30 days and three years. Kaplan-Meier survival curves show the all-cause death rate in PCI patients stratified by HF with high BNP levels (>100 pg/ml) and 30-day bleeding. P-values were calculated using the log-rank test. HF, heart failure; BNP, brain natriuretic peptide; PCI, percutaneous coronary intervention.
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