title: Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS.
abstract: BACKGROUND
  Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking.
  
  
  OBJECTIVE
  The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after percutaneous coronary intervention with drug-eluting stents.
  
  
  METHODS
  Using data from 4,190 patients treated with drug-eluting stents and enrolled in the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) registry, separate risk scores were developed to predict CTE (defined as the composite of stent thrombosis or myocardial infarction) and MB (defined as the occurrence of a Bleeding Academic Research Consortium type 3 or 5 bleed). External validation was performed in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) registry.
  
  
  RESULTS
  Over 2 years, CTEs occurred in 151 patients (3.8%) and MB in 133 (3.3%). Independent predictors of CTEs included acute coronary syndrome, prior revascularization, diabetes mellitus, renal dysfunction, and current smoking. Independent predictors of MB included older age, body mass index, triple therapy at discharge, anemia, current smoking, and renal dysfunction. Each model displayed moderate levels of discrimination and adequate calibration.
  
  
  CONCLUSIONS
  Simple risk scores of baseline clinical variables may be useful to predict risks for ischemic and bleeding events after PCI with DES, thereby facilitating clinical decisions surrounding the optimal duration of DAPT. (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients [PARIS]; NCT00998127).
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Minneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Claire
authors.initials: C
authors.lastname: Litherland
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.affiliation: University of Kentucky, Lexington, Kentucky.
authors.forename: David J
authors.initials: DJ
authors.lastname: Moliterno
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.affiliation: Helios Amper-Klinikum, Dachau, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D015992:Body Mass Index; D000077144:Clopidogrel; D015331:Cohort Studies; D003328:Coronary Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: PCI; bleeding; risk; thrombosis