Effect of Bleeding Risk on Type of Stent Used in Patients Presenting With Acute Coronary Syndrome

M. Chadi Alraies, Sang Yeub Lee, Michael J. Lipinski, Kyle Buchanan, Arie Steinvil, Toby Rogers, Edward Koifman, Jiaxiang Gai, Rebecca Torguson, Itsik Ben-Dor, Lowell F. Satler, Augusto D. Pichard, Ron Waksman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Patients at high bleeding risk (HBR) are at increased risk of bleeding following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) due to the need for longer dual antiplatelet duration. We sought to evaluate the likelihood of receiving DES during PCI in HBR populations and to characterize DES utilization trends over time. Consecutive patients who underwent PCI from April 2003 to September 2015 were identified. HBR is defined as patients fulfilling 1 or more of the HBR criteria: age ≥75 years, anticoagulation use at discharge, history of stroke, cancer in previous 3 years, glucocorticoid use, hemoglobin (Hgb) <11 g/dl, platelet count <100,000/mm3, or creatinine clearance (CCr) <40 ml/min. Multivariate analysis was performed to identify which variables predicted DES selection. There were 10,594 patients (41.6%) who the met HBR definition. When adjusting for known risk factors, HBR patients were less likely to receive a DES compared with non-HBR patients (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.54 to 0.62, p <0.001). A preprocedural Hgb <11 g/dl had the greatest association with choosing DES during PCI (OR 0.51, 95% CI 0.45 to 0.57, p <0.001). Within the HBR patients, having 3 or more HBR criteria versus <3 HBR criteria had lower likelihood of receiving a DES (OR 0.50, 95% CI 0.44 to 0.57, p <0.001). In conclusion, presence of HBR has a significant impact upon the decision to use DES.

Original languageEnglish
Pages (from-to)1272-1278
Number of pages7
JournalAmerican Journal of Cardiology
Issue number8
StatePublished - 15 Oct 2017
Externally publishedYes


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