title: Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention.
abstract: BACKGROUND
  The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear.
  
  
  OBJECTIVE
  This study sought to characterize the determinants and consequences of PDB after PCI.
  
  
  METHODS
  The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression.
  
  
  RESULTS
  Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009).
  
  
  CONCLUSIONS
  After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).
authors: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors: Philippe
authors: P
authors: Généreux
authors: Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Gennaro
authors: G
authors: Giustino
authors: Helios Amper-Klinikum, Dachau, Germany.
authors: Bernhard
authors: B
authors: Witzenbichler
authors: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York; Shaare Zedek Medical Center, Jerusalem, Israel.
authors: Giora
authors: G
authors: Weisz
authors: LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina.
authors: Thomas D
authors: TD
authors: Stuckey
authors: Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, North Carolina.
authors: Michael J
authors: MJ
authors: Rinaldi
authors: Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany.
authors: Franz-Josef
authors: FJ
authors: Neumann
authors: Wellmont CVA Heart Institute, Kingsport, Tennessee.
authors: D Christopher
authors: DC
authors: Metzger
authors: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Medical Center, Los Angeles, California.
authors: Timothy D
authors: TD
authors: Henry
authors: Lehigh Valley Health Network, Allentown, Pennsylvania.
authors: David A
authors: DA
authors: Cox
authors: Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, North Carolina.
authors: Peter L
authors: PL
authors: Duffy
authors: The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors: Ernest
authors: E
authors: Mazzaferri
authors: Cardiovascular Research Foundation, New York, New York.
authors: Mayank
authors: M
authors: Yadav
authors: Cardiovascular Research Foundation, New York, New York.
authors: Dominic P
authors: DP
authors: Francese
authors: Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
authors: Tullio
authors: T
authors: Palmerini
authors: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York.
authors: Ajay J
authors: AJ
authors: Kirtane
authors: Cardiovascular Research Foundation, New York, New York.
authors: Claire
authors: C
authors: Litherland
authors: Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Roxana
authors: R
authors: Mehran
authors: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York. Electronic address: gs2184@columbia.edu.
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: late bleeding; mortality; platelet reactivity