Thromb Haemost 2019; 119(07): 1182-1193
DOI: 10.1055/s-0039-1688792
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Development and Validation of an Ischemic and Bleeding Risk Evaluation Tool in East Asian Patients Receiving Percutaneous Coronary Intervention

Jeehoon Kang
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Kyung Woo Park
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
You-Jeong Ki
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Jiesuck Park
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Taemin Rhee
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Chee-Hoon Kim
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Jung-Kyu Han
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Han-Mo Yang
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Hyun-Jae Kang
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Bon-Kwon Koo
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
,
Masato Nakamura
2  Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
,
3  Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
,
Hiroyoshi Yokoi
4  Department of Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
,
David Cohen
5  Saint Luke's Mid America Heart Institute, Kansas City, Missouri, United States
,
Hyo-Soo Kim
1  Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
› Author Affiliations
Funding None.
Further Information

Publication History

23 November 2018

03 April 2019

Publication Date:
12 May 2019 (eFirst)

Abstract

Background The ischemic/bleeding risk of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is still uncertain. We sought to develop a tool to predict ischemic and bleeding events in East Asians receiving 2nd generation drug-eluting stents (DESs) PCI.

Methods A pooled cohort of 13,172 East Asian patients receiving PCI with 2nd generation DES (the Grand DES cohort) was analyzed to develop a scoring system. A net score was calculated by subtracting the bleeding score from the ischemic score. External validation was performed in the HOST-ASSURE and NIPPON trials.

Results Among the total population, ischemic and bleeding events occurred in 195 patients (1.5%) and 166 patients (1.3%), respectively. The score to predict ischemic events included previous myocardial infarction (MI) or PCI, presentation as acute MI, anemia, stent diameter < 3 mm, and total stent length of ≥30 mm, while that for bleeding events included older age, low creatinine clearance, and anemia. C-statistics of the ischemic and bleeding model was 0.708 and 0.665, respectively. Patients with a net score of ≥1 had a higher ischemic risk compared with bleeding risk, and patients with a net score of ≤–1 had a higher bleeding risk compared with ischemic risk. The validation cohort showed a C-statistic of 0.647 for ischemic events and 0.633 for bleeding events.

Conclusion We developed a tool to predict ischemic and bleeding events in East Asian patients received PCI with 2nd generation DES. This system can be used to assess clinical event risks, and to determine the adequate duration of DAPT in East Asians.

Supplementary Material