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. 2023 Dec 7;10(2):e002489.
doi: 10.1136/openhrt-2023-002489.

BNP level predicts bleeding event in patients with heart failure after percutaneous coronary intervention

Yasuhiro Otsuka  1 , Masanobu Ishii  2 , So Ikebe  1 , Taishi Nakamura  1   3 , Kenichi Tsujita  1 , Koichi Kaikita  4 , Tetsuya Matoba  5 , Takahide Kohro  6 , Yusuke Oba  7 , Tomoyuki Kabutoya  7 , Kazuomi Kario  7 , Yasushi Imai  8 , Arihiro Kiyosue  9 , Yoshiko Mizuno  9   10 , Kotaro Nochioka  11 , Masaharu Nakayama  12 , Takamasa Iwai  13 , Yoshihiro Miyamoto  14 , Hisahiko Sato  15 , Naoyuki Akashi  16 , Hideo Fujita  16 , Ryozo Nagai  17 ; CLIDAS research group
Affiliations

BNP level predicts bleeding event in patients with heart failure after percutaneous coronary intervention

Yasuhiro Otsuka et al. Open Heart. .

Abstract

Objective: This study aimed to investigate the association between heart failure (HF) severity measured based on brain natriuretic peptide (BNP) levels and future bleeding events after percutaneous coronary intervention (PCI).

Background: The Academic Research Consortium for High Bleeding Risk presents a bleeding risk assessment for antithrombotic therapy in patients after PCI. HF is a risk factor for bleeding in Japanese patients.

Methods: Using an electronic medical record-based database with seven tertiary hospitals in Japan, this retrospective study included 7160 patients who underwent PCI between April 2014 and March 2020 and who completed a 3-year follow-up and were divided into three groups: no HF, HF with high BNP level and HF with low BNP level. The primary outcome was bleeding events according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries classification of moderate and severe bleeding. The secondary outcome was major adverse cardiovascular events (MACE). Furthermore, thrombogenicity was measured using the Total Thrombus-Formation Analysis System (T-TAS) in 536 consecutive patients undergoing PCI between August 2013 and March 2017 at Kumamoto University Hospital.

Results: Multivariate Cox regression showed that HF with high BNP level was significantly associated with bleeding events, MACE and all-cause death. In the T-TAS measurement, the thrombogenicity was lower in patients with HF with high BNP levels than in those without HF and with HF with low BNP levels.

Conclusions: HF with high BNP level is associated with future bleeding events, suggesting that bleeding risk might differ depending on HF severity.

Keywords: biomarkers; heart failure; percutaneous coronary intervention.

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Conflict of interest statement

Competing interests: TM received research grants from Amgen and honoraria from Abbott Medical and Bayer. TK received scholarship funds from Abbott Medical. YI received honoraria from Daiichi Sankyo and Toa Eiyo. KKario received research grants and honoraria from Sanwa Kagaku Kenkyusho. AK received honoraria from AstraZeneca, Eli Lilly and Sumitomo Pharma. YMizuno received research grants and consulting fees from Bayer. KT received research grants from PPD-Shin Nippon Biomedical Laboratories and Alexion Pharmaceuticals; and scholarship funds from Abbott Medical, Bayer, Boehringer Ingelheim, Daiichi Sankyo, ITI, Ono Pharmaceutical, Otsuka Pharmaceutical and Takeda Pharmaceutical; affiliation with the endowed department from Abbott Medical, Boston Scientific, Cardinal Health, Fides-ONE, Fukuda Denshi, GM Medical, ITI, Japan Lifeline, Kaneka Medix, Medical Appliance, Medtronic, Nipro and Terumo and honoraria from Abbott Medical, Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Medtronic, Kowa, Novartis Pharma, Otsuka Pharmaceutical, Pfizer and Janssen Pharmaceutical. HS reports stock or stock options in Precision. HF received consulting fees from Mehergen Group Holdings; and honoraria from Novartis Pharma and Otsuka Pharmaceutical. RN received honoraria from Kowa, Takeda Pharmaceutical, Tanabe-Mitsubishi Pharmaceutical and Boehringer-Ingelheim. All other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier estimates of bleeding events (GUSTO severe/moderate) between non-HF groups and the HF groups classified according to BNP, EF level, ischaemic aetiology. Kaplan-Meier curves show the rate of major bleeding events after PCI according to HF and severity (BNP and EF level). The bleeding event rate was significantly higher in the HF with high BNP level group than in the non-HF group. There was no difference in the rate of major bleeding events among patients with HF, regardless of the EF. BNP, brain natriuretic peptide; EF, ejection fraction; GUSTO, Global Use of Streptokinase and t-PA for Occluded Coronary Arteries; HF, heart failure; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan-Meier estimates of MACE and all-cause death. Kaplan-Meier curves show the rates of MACE and all-cause death after PCI according to HF and severity (BNP level). The MACE and all-cause rates were significantly higher in the HF with high BNP level group than in the other groups. BNP, brain natriuretic peptide; HF, heart failure; MACE, major adverse cardiac events; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Total Thrombus-Formation Analysis System level in patients with and without HF and patients with HF with high BNP levels, HF with low BNP levels and without HF. Upper box plot shows the level of PL-AUC in patients with and without HF and patients according to HF and severity (BNP level). Lower box plot shows the level of AR-AUC in patients with and without HF and patients according to HF and severity (BNP level). AR, atheroma chip; AUC, area under the curve; BNP, B-type natriuretic peptide; HF, heart failure; PL, platelet chip.
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