Toshiharu Fujii, Emad Abu-Assi, Gaetano M. De Ferrari, Pedro Flores Blanco, Mariano Valdés, Sebastiano Gili, Lazar Velicki, Alessandro Durante, Ugo Fabrizio, José P.S. Henriques, Dimitrios Alexopoulos, Giulia Magnani, María Cespón Fernández, Fabrizio D'Ascenzo, Tim Kinnaird, Federico Gaido, Giacomo Boccuzzi, Salma Taha, Christian Templin, Giuseppe Biondi-Zoccai, Masa-aki Kawashiri, Christoph Liebetrau, Tetsuma Kawaji, Andrea Rognoni, Gregg W. Stone, Alberto Garay, Federica Bongiovanni, Zenon Huczek, José Ramón González-Juanatey, Alberto Dominguez-Rodriguez, Giorgio Quadri, Angel Cequier, Albert Ariza-Solé, Berenice Caneiro Queija, Sergio Manzano-Fernández, Stephen B. Wilton, Luis C. L. Correia, Michele Autelli, Rafael Cobas Paz, Andrea Montabone, Isabel Muñoz Pousa, Pierluigi Omedè, Andrés Íñiguez-Romo, Sergio Raposeiras-Roubín, Carloalberto Biolè, Alberto Grosso, Iván J. Núñez-Gil, Ioanna Xanthopoulou, Umberto Morbiducci, Shaoping Nie, Xiantao Song, Sara Rettegno, Federico Conrotto, Diego Gallo, Enrico Cerrato, Cardiology, and ACS - Atherosclerosis & ischemic syndromes
BACKGROUND The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies. METHODS BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup. RESULTS A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively). CONCLUSIONS In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.