title: Frequency and predictors of bleeding events after 2nd generation drug-eluting stent implantation differ depending on time after implantation.
abstract: Antiplatelet therapy is required after drug-eluting stent (DES) implantation, but bleeding events occur unexpectedly. We aimed to assess whether bleeding event predictors after 2nd generation DES (2nd DES) implantation differed by time after implantation.
  
  
  
  We studied 1912 consecutive patients who underwent successful 2nd DES implantation (70±10 years, 72% male). Bleeding events were recorded as early (≤1 year) and late (>1 year). Major bleeding events were defined as a composite of type 5, 3, and 2 bleeding in the Bleeding Academic Research Consortium criteria. Predictors were assessed using a Cox proportional hazard model.
  
  
  
  Bleeding event rates were 3.3%, 5.1%, and 6.7% at 1, 2, and 3 years, respectively, with the highest 1-year rate in year 1 (p<0.001). Cause and severity of bleeding events were similar between early and late bleeding events. Prior history of gastrointestinal bleeding, non-steroidal anti-inflammatory drug use, and triple antithrombotic therapy [adjusted risk ratio (RR): 3.68, 3.21, 4.57, respectively; p<0.01] were independent predictors of early bleeding events. Age >80 years and severe renal dysfunction (adjusted RR: 2.27, 2.02, respectively; p<0.01) were independent predictors of late bleeding events. Survival rate was significantly lower in patients with bleeding events compared with patients without bleeding events (82.4% vs 90.1%; p<0.001).
  
  
  
  Frequency and predictors of bleeding events after 2nd DES implantation differ by time after implantation. Treatment strategies corresponding to individual patients are required.
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan. Electronic address: rum-tum-tugger.1218@hotmail.co.jp.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mori
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Makino
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tokuda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takafuji
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Takama
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tsutumi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antithrombotic therapy; Bleeding event; Drug-eluting stent; Prognosis