title: Impact of Bleeding on Quality of Life in Patients on DAPT: Insights From TRANSLATE-ACS.
abstract: BACKGROUND
  Prolonged dual antiplatelet therapy (DAPT) is recommended after an acute myocardial infarction (AMI) to reduce ischemic events but is associated with increased rates of major and minor bleeding.
  
  
  OBJECTIVE
  This study sought to determine the incidence of post-percutaneous coronary intervention (PCI) bleeding that occurs on contemporary DAPT and its impact on quality of life (QOL).
  
  
  METHODS
  We studied 9,290 AMI patients treated with PCI and discharged alive between April 2010 and September 2012. Post-discharge bleeding was categorized according to the Bleeding Academic Research Consortium (BARC) definition. The primary outcome was the 6-month Euro QOL-5 Dimension (EQ-5D) index score (a measure of health utility); a secondary outcome was the EQ-5D visual analog scale (VAS) at 6 months.
  
  
  RESULTS
  Of the 9,290 patients with AMI, bleeding events occurred as follows: any BARC bleeding: 24.2%; BARC 1: 9.1%; BARC 2: 13.8%; BARC 3: 1.1%; BARC 4: 0.03%; and BARC 5: 0%. Those who experienced any BARC bleeding had lower scores across all 5 EQ-5D domains (mobility, self-care, usual activities, pain, and anxiety), as well as lower EQ-5D VAS and EQ-5D index scores. After clinical risk adjustment, any BARC bleeding was independently associated with 6-month EQ-5D index score (p < 0.0001) and lower QOL (p < 0.001). Both the EQ-5D index and the VAS score declined in a stepwise fashion with increasing BARC severity.
  
  
  CONCLUSIONS
  Among patients undergoing PCI for AMI, bleeding during follow-up was associated with worse 6-month utility and QOL. Although even minor bleeding was associated with impaired health status and QOL, the degree of impairment increased in a stepwise fashion with bleeding severity.
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri; Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.affiliation: Lilly Research Laboratories, Indianapolis, Indiana.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Lilly Research Laboratories, Indianapolis, Indiana.
authors.forename: Lisa
authors.initials: L
authors.lastname: McCoy
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri; Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.affiliation: Lilly Research Laboratories, Indianapolis, Indiana.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: dcohen@saint-lukes.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000523:psychology; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D011788:Quality of Life; D057566:Self Report
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists
keywords: antiplatelet therapy; bleeding; percutaneous coronary intervention; quality of life