Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease
Abstract This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, pa...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Nature Publishing Group
2020-12-01
|
Series: | Scientific Reports |
Online Access: | https://doi.org/10.1038/s41598-020-78400-4 |
id |
doaj-d712270185d34c808b41d127b098eaf3 |
---|---|
record_format |
Article |
spelling |
doaj-d712270185d34c808b41d127b098eaf32020-12-08T10:19:53ZengNature Publishing GroupScientific Reports2045-23222020-12-011011910.1038/s41598-020-78400-4Impact of bleeding during dual antiplatelet therapy in patients with coronary artery diseaseYing-Chang Tung0Lai-Chu See1Shu-Hao Chang2Jia-Rou Liu3Chi-Tai Kuo4Chi-Jen Chang5Cardiovascular Department, Linkou Chang Gung Memorial HospitalDepartment of Public Health, College of Medicine, Chang Gung UniversityDepartment of Public Health, College of Medicine, Chang Gung UniversityDepartment of Public Health, College of Medicine, Chang Gung UniversityCardiovascular Department, Linkou Chang Gung Memorial HospitalCardiovascular Department, Linkou Chang Gung Memorial HospitalAbstract This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS.https://doi.org/10.1038/s41598-020-78400-4 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ying-Chang Tung Lai-Chu See Shu-Hao Chang Jia-Rou Liu Chi-Tai Kuo Chi-Jen Chang |
spellingShingle |
Ying-Chang Tung Lai-Chu See Shu-Hao Chang Jia-Rou Liu Chi-Tai Kuo Chi-Jen Chang Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease Scientific Reports |
author_facet |
Ying-Chang Tung Lai-Chu See Shu-Hao Chang Jia-Rou Liu Chi-Tai Kuo Chi-Jen Chang |
author_sort |
Ying-Chang Tung |
title |
Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
title_short |
Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
title_full |
Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
title_fullStr |
Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
title_full_unstemmed |
Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
title_sort |
impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2020-12-01 |
description |
Abstract This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS. |
url |
https://doi.org/10.1038/s41598-020-78400-4 |
work_keys_str_mv |
AT yingchangtung impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease AT laichusee impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease AT shuhaochang impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease AT jiarouliu impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease AT chitaikuo impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease AT chijenchang impactofbleedingduringdualantiplatelettherapyinpatientswithcoronaryarterydisease |
_version_ |
1724389785817055232 |