Author + information
- Received August 20, 2010
- Revision received November 19, 2010
- Accepted December 9, 2010
- Published online April 1, 2011.
- Young-Hak Kim, MD, PhD⁎,
- Jong-Young Lee, MD⁎,
- Jung-Min Ahn, MD⁎,
- Haegeun Song, MD⁎,
- Won-Jang Kim, MD⁎,
- Sung-Cheol Yun, PhD†,
- Duk-Woo Park, MD, PhD⁎,
- Soo-Jin Kang, MD, PhD⁎,
- Seung-Whan Lee, MD, PhD⁎,
- Cheol Whan Lee, MD, PhD⁎,
- Seong-Wook Park, MD, PhD⁎ and
- Seung-Jung Park, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Seung–Jung Park, Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, 388–1 Poongnap–dong, Songpa–gu, Seoul, 138–736 South Korea
Objectives The aim of this study was to assess the impact of early and late bleeding on subsequent mortality after drug-eluting stent (DES) implantation.
Background Little is known about the impact of late bleeding after DES implantation.
Methods With a time-updated Cox model, the impact of bleeding and myocardial infarction (MI) on 3-year mortality was analyzed in 3,148 consecutive patients who underwent DES implantation for coronary disease.
Results Bleeding, defined according to STEEPLE (Safety and Efficacy of Enoxaparin in PCI Patients, an International Randomized Evaluation) minor or major criteria, occurred in 6.5% of patients over 3 years. Patients with bleeding were older; were more likely to be female; had higher rates of diabetes mellitus, hypertension, and extensive coronary disease and lower ventricular function; and underwent more complex procedures than those without bleeding. The 3-year adjusted hazard ratios (HRs) for mortality were 5.81 (95% confidence interval [CI]: 3.92 to 8.60; p < 0.001) for patients with bleeding and 2.53 (95% CI: 1.62 to 3.96; p < 0.001) for patients with MI. When the timings of events were separated, the HRs for mortality were 4.89 (95% CI: 3.08 to 7.78; p < 0.001) and 7.81 (95% CI: 4.39 to 13.89; p < 0.001) for patients with bleeding within and after 30 days, respectively. By contrast, the HRs for mortality were 1.85 (95% CI: 1.09 to 3.14, p = 0.022) and 10.33 (95% CI: 4.91 to 21.75, p < 0.001) for patients with MI within and after 30 days, respectively.
Conclusions Bleeding is closely associated with mortality during both the early and late periods after DES implantation. Therefore, in addition to carefully assessing bleeding after stenting, evidence-based treatment should be implemented to offer the best balance of benefit and harm.
All of the authors report partial grant support from the Korean Society of Interventional Cardiology, Health 21 R&D Project, Ministry of Health & Welfare, Korea (#0412-CR02-0704-0001), and the CardioVascular Research Foundation.
- Received August 20, 2010.
- Revision received November 19, 2010.
- Accepted December 9, 2010.
- American College of Cardiology Foundation