title: The association between the extent of coronary artery disease and major bleeding events after percutaneous coronary intervention: from the ACUITY trial.
abstract: OBJECTIVE
  We sought to evaluate the relation between the extent of coronary artery disease (CAD) and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndrome (NSTEACS).
  
  
  BACKGROUND
  Patients with severe CAD undergoing PCI for NSTEACS are at high risk for recurrent adverse events. Hemorrhagic events after PCI are associated with high rates of morbidity and mortality. Despite sharing many common risk factors, the relationship between the extent of CAD and bleeding after PCI remains understudied.
  
  
  METHODS
  The SYNTAX score (SS) was used to quantify the extent and severity of CAD. We stratified 2627 patients from the ACUITY PCI cohort into SS groups based on score tertiles from the ACUITY trial (<7, 7-12, and >12). Thirty-day major bleeding rates were determined for each group.
  
  
  RESULTS
  When stratified by ACUITY tertiles, 30-day major bleeding rates were significantly greater in the highest SS tertile (>12) than in the intermediate and lowest tertiles (P<.01). By multivariable analysis, the SS (by augmentation of 1 point) remained independently associated with 30-day major bleeding (hazard ratio = 1.03; 95% confidence interval, 1.01-1.04; P<.01).
  
  
  CONCLUSIONS
  The results of this large-scale study suggest that in addition to its previously described association with adverse ischemic events, the extent of CAD, as assessed by the SS, was independently associated with major bleeding after PCI for NSTEACS.
authors.affiliation: Columbia University Medical Center, The Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022 USA. pg2295@columbia.edu.
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Madhavan
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Thomas C
authors.initials: TC
authors.lastname: McAndrew
authors.forename: Dominic P
authors.initials: DP
authors.lastname: Francese
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors