Changes in Systolic Blood Pressure During Hospitalisation and Bleeding Events After Percutaneous Coronary Intervention

Overview

Journal Open Heart

Publisher BMJ Publishing Group

Specialty Cardiology & Vascular Diseases

Date 2024 Dec 24

PMID 39719275

Authors

Yasuhiro Otsuka

Masanobu Ishii

So Ikebe

Taishi Nakamura

Kenichi Tsujita

Tetsuya Matoba

Takahide Kohro

Yusuke Oba

Tomoyuki Kabutoya

Kazuomi Kario

Yasushi Imai

Arihiro Kiyosue

Yoshiko Mizuno

Kotaro Nochioka

Masaharu Nakayama

Takamasa Iwai

Yoshihiro Miyamoto

Hisahiko Sato

Naoyuki Akashi

Hideo Fujita

Ryozo Nagai

Affiliations

Soon will be listed here.

Abstract

Background: Hypertension is a risk factor for bleeding events and is included in the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol concomitantly)score. However, the effects of blood pressure (BP) and changes in BP on bleeding events in patients undergoing percutaneous coronary intervention (PCI) remain poorly understood. This study is aimed to investigate the relationship between systolic BP (SBP) changes during hospitalisation and bleeding events in patients undergoing PCI.

Methods: From the Clinical Deep Data Accumulation System database, a multicentre database encompassing seven tertiary medical hospitals in Japan that includes data for patient characteristics, medications, laboratory tests, physiological tests, cardiac catheterisation and PCI treatment, data for 6351 patients undergoing PCI between April 2013 and March 2019 were obtained. The study population was categorised into three groups based on the changes in SBP during hospitalisation: (1) elevated BP (≥20 mm Hg), (2) no change (≥-20 to <20 mm Hg) and (3) decreased BP (<-20 mm Hg) groups. The primary outcome was a 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria.

Results: The elevated BP group exhibited significantly lower SBP at admission and higher SBP at discharge (p<0.001). Multivariable Cox hazard regression models showed that elevated BP was associated with a high risk of bleeding events (HR: 1.885; 95% CI, 1.294 to 2.748). The multivariable logistic regression model identified female sex, chronic coronary syndrome, peripheral artery disease and chronic kidney disease as independent factors associated with elevated BP.

Conclusions: These findings suggest that BP management is essential to prevent bleeding events after PCI.

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