title: Predicting long-term bleeding after percutaneous coronary intervention.
abstract: OBJECTIVE
  To construct a model to predict long-term bleeding events following percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Treatment with dual antiplatelet therapy following PCI involves balancing the benefits of preventing ischemic events with the risks of bleeding. There are no models to predict long-term bleeding events after PCI.
  
  
  METHODS
  We analyzed 1-year bleeding outcomes from 3,128 PCI procedures in the Patient Risk Information Services Manager (PRISM) observational study. Patient-reported bleeding events were categorized according to Bleeding Academic Research Consortium (BARC) definitions. Logistic regression analysis was used to develop a model predicting BARC ≥ 1 bleeding.
  
  
  RESULTS
  BARC 0, 1, 2 or 3 bleeding was observed in 574 (18.4%); 2382 (76.2%); 114 (3.6%); and 58 (1.8%) patients, respectively. Compared to patients who had no bleeding, patients with BARC ≥ 1 bleeding were more often female (30 vs. 23%), Caucasian (94 vs. 83%), had a higher incidence of drug eluting stent (DES) implantation (83 vs. 76%) and warfarin therapy (7.4 vs. 3.9%), and a lower incidence of diabetes (31 vs. 45%; P-value <0.01 for all comparisons). A 27-variable model had moderate discrimination (c-statistic of 0.674), and good calibration, as did a parsimonious model with 10 variables (c-statistic = 0.667). This model performed well in predicting BARC ≥ 2 bleeding events as well (c-statistic = 0.653).
  
  
  CONCLUSIONS
  Bleeding is common in the first year after PCI, and can be predicted by pre-procedural patient characteristics and use of DES. Objective estimates of bleeding risk may help support shared decision-making with respect to stent selection and duration of antiplatelet therapy following PCI. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Praneet K
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Adnan K
authors.initials: AK
authors.lastname: Chhatriwalla
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.affiliation: University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Paramdeep
authors.initials: P
authors.lastname: Baweja
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.affiliation: Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000368:Aged; D015897:Comorbidity; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: PCI; antiplatelet therapy; bleeding; drug eluting stent