Поздние кровотечения после стентирования сердца опаснее для жизни, чем повторные инфаркты

TOPLINE Ischaemic complications, bleeding complications, and their combination during hospitalisation for percutaneous coronary intervention (PCI) were all associated with a higher risk for in-hospital mortality, whereas bleeding complications occurring beyond 24 weeks after discharge were more strongly associated with mortality than late ischaemic complications. METHODOLOGY - Drawing on data from a French PCI registry, researchers examined how ischaemic and bleeding complications were associated with mortality according to when they occurred after PCI. - They analysed data of 54,599 patients (median age, 69.0 years; 74.9% men) who underwent PCI in France between 2014 and 2020; of these, 52.9% underwent PCI for acute coronary syndromes or cardiac arrest. - Ischaemic complications were defined as stent thrombosis, myocardial infarction, stroke, or unplanned coronary revascularisation, and bleeding complications were defined according to the Bleeding Academic Research Consortium scale as type 3 or greater. - The primary outcome was all-cause mortality, assessed separately during the hospitalisation for PCI and within 12 months after discharge. TAKEAWAY - During the hospitalisation for PCI, ischaemic and bleeding complications occurred in 1.1% and 1.0% of patients, respectively, and 0.1% experienced both complications; the in-hospital mortality rate was 2.1%. - Ischaemic complications, bleeding complications, and the combination of both were associated with higher odds of in-hospital mortality (adjusted odds ratio, 8.4, 10.3, and 13.2, respectively; P < .001 for all). - After discharge, ischaemic complications remained associated with a higher risk for mortality, although the strength of this association declined over time, with adjusted hazard ratios (aHRs) of 9.9 during weeks 0-8, 3.8 during weeks 8-24, and 2.5 during weeks 24-52. - Bleeding complications after discharge showed a similar pattern but remained more strongly associated with mortality later during follow-up, with aHRs of 7.4 during weeks 8-24 and 6.0 during weeks 24-52, exceeding those observed with ischaemic complications. IN PRACTICE "Bleeding complications late after discharge seem to bear a higher risk of subsequent death than ischemic complications. Therefore, prolonged DAPT [dual antiplatelet therapy] needs a careful evaluation of the benefit-risk balance," the researchers wrote. SOURCE The study was led by Louis Giovachini, Sorbonne Université, Paris, France. It was published online on August 22, 2026, in the International Journal of Cardiology. LIMITATIONS The observational study design limited causal inference, and residual confounding may have persisted despite multivariable adjustment. The analysis did not assess minor bleeding events and did not incorporate established ischaemic or bleeding risk scores. Follow-up was limited to 12 months, preventing the assessment of the long-term risk for mortality, and the composite ischaemic and bleeding endpoints may have combined events with differing prognostic significance. DISCLOSURES The study was supported by the ACTION Study Group. Several authors disclosed receiving consulting fees, lecture fees, research funds, fees, or contribution to transport costs from multiple companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.