Post-discharge bleeding among ACS patients: Does PCI have a fatal effect?

Post-discharge bleeding events are a serious, sometimes fatal complication associated with treating acute coronary syndrome (ACS) patients with percutaneous coronary intervention (PCI). Should this increased risk of mortality make specialists think twice when considering PCI?

An international group of researchers explored this very question, sharing their findings in the Journal of the American College of Cardiology.

“Understanding to what extent the risk for bleeding should be incorporated into the informed shared decision-making process regarding dual antiplatelet therapy (DAPT) duration and intensity requires a comprehension of the impact of bleeding,” wrote first author Guillaume Marquis-Gravel, MD, MSc, Duke Clinical Research Institute in Durham, North Carolina, and colleagues. “If the effect of post-discharge bleeding on subsequent mortality after an ACS is modified by PCI status, and is lower in patients treated with medical therapy alone, patients and their physicians may be more willing to accept the risk for excess bleeding with longer DAPT durations in this population.”

To examine this connection between ACS treatment strategies and all-cause mortality, Marquis-Gravel and colleagues tracked data from more than 45,000 ACS patients who participated in one of four multicenter randomized trials. There were 1,133 post-discharge bleeding events among those patients. The team also identified 2,149 total patient deaths during follow-up, and a majority (1,928) of those deaths did not involve a bleeding event.

Overall, post-discharge bleeding events were associated with a “significantly higher risk” of all-cause mortality, and this was true both in the initial 30 days following the bleeding event and in the following 11 months. The association between bleeding and mortality extended across all four randomized trials, the authors emphasized—and including PCI as part of the treatment strategy did not affect the patient’s risk of death.

The association between experiencing a post-discharge MI and the risk of mortality was also the same for patients treated with and without PCI.

“These findings suggest that integrated and customized antithrombotic treatment strategies are needed to mitigate the risks for both post-ACS bleeding and MI across the entire spectrum of patients with ACS treated with or without PCI,” the authors concluded. “Future studies are required to understand better the impact of different bleeding severity categories on the prognosis of patients with ACS treated with or without PCI.”

The full study is available here.