Skip to main content
SpringerLink
Log in

Impact of bleeding events after percutaneous coronary intervention in patients on hemodialysis

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Coronary artery disease is common in patients on dialysis; there is a high rate of bleeding events after percutaneous coronary intervention (PCI) in such patients. We investigated the impact of bleeding events after PCI on mortality in patients on hemodialysis. We included 386 consecutive hemodialysis patients who underwent PCI using a drug-eluting stent (DES) between September 2004 and December 2017 in our hospital, and investigated the impact of bleeding events on all-cause mortality after PCI. Bleeding events were assessed by the Thrombolysis in Myocardial Infarction (TIMI) bleeding definition within 24 months after PCI. A total of 42 patients experienced bleeding events. Of these, 30 patients (71.4%) had TIMI major bleeding events and 12 patients (28.6%) had TIMI minor bleeding events. Patients with bleeding events had significantly higher mortality than patients without bleeding events (survival rate, 55.1% vs 81.5%, log-rank: p < 0.001). These results suggest that bleeding events after PCI with a DES are notably associated with all-cause mortality among patients on hemodialysis. This is the first report about relationship between bleeding events and mortality to focus on patients on hemodialysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Valle JA, Shetterly S, Maddox TM, Ho PM, Bradley SM, Sandhu A, Magid D, Tsai TT (2016) Postdischarge bleeding after percutaneous coronary intervention and subsequent mortality and myocardial infarction: insights from the HMO Research Network-Stent Registry. Circ Cardiovasc Interv 9:e003519

    Article  Google Scholar 

  2. Mehran R, Pocock S, Nikolsky E, Dangas GD, Clayton T, Claessen BE, Caixeta A, Feit F, Manoukian SV, White H, Bertrand M, Ohman EM, Parise H, Lansky AJ, Lincoff AM, Stone GW (2011) Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials. JACC Cardiovasc Interv 4:654–664

    Article  Google Scholar 

  3. Iseki K, Kinjo K, Kimura Y, Osawa A, Fukiyama K (1993) Evidence for high risk of cerebral hemorrhage in chronic dialysis patients. Kidney Int 44:1086–1090

    Article  CAS  Google Scholar 

  4. Cheung AK, Sarnak MJ, Yan G, Berkoben M, Heyka R, Kaufman A, Lewis J, Rocco M, Toto R, Windus D, Ornt D, Levey AS, HEMO Study Group (2004) Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 65:2380–2389

    Article  Google Scholar 

  5. Foley RN, Parfrey PS, Sarnak MJ (1998) Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 9:S16–S23

    CAS  PubMed  Google Scholar 

  6. Ishii H, Toriyama T, Aoyama T, Takahashi H, Tanaka M, Yoshikawa D, Hayashi M, Yasuda Y, Maruyama S, Matsuo S, Matsubara T, Murohara T (2012) Percutaneous coronary intervention with bare metal stent vs. drug-eluting stent in hemodialysis patients. Circ J 76:1609–1615

    Article  Google Scholar 

  7. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN, ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies (2018) 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 39:213–260

    Article  Google Scholar 

  8. Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Zanchin T, Palmerini T, Wallentin L, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M, PRECISE-DAPT Study Investigators (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389:1025–1034

    Article  Google Scholar 

  9. Kimura T, Morimoto T, Nakagawa Y, Kawai K, Miyazaki S, Muramatsu T, Shiode N, Namura M, Sone T, Oshima S, Nishikawa H, Hiasa Y, Hayashi Y, Nobuyoshi M, Mitudo K, j-Cypher Registry I (2012) Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry. Circulation 125:584–591

    Article  CAS  Google Scholar 

  10. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P (1987) Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76:142–154

    Article  CAS  Google Scholar 

  11. Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (2007) Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 356:1020–1029

    Article  CAS  Google Scholar 

  12. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (2018) Fourth universal definition of myocardial infarction. Circulation 138:e618–e651

    Article  Google Scholar 

  13. Ellis SG, Popma JJ, Lasala JM, Koglin JJ, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Stone GW (2005) Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation: analysis from the TAXUS-IV trial. J Am Coll Cardiol 45:1193–1200

    Article  Google Scholar 

  14. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747

    Article  Google Scholar 

  15. Stone GW, Bertrand M, Colombo A, Dangas G, Farkouh ME, Feit F, Lansky AJ, Lincoff AM, Mehran R, Moses JW, Ohman M, White HD (2004) Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J 148:764–775

    Article  Google Scholar 

  16. Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Dangas G, Wong SC, Kirtane AJ, Parise H, Mehran R, Trial Investigators HORIZONS-AMI (2008) Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 358:2218–2230

    Article  CAS  Google Scholar 

  17. Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ (2004) Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA 292:696–703

    Article  CAS  Google Scholar 

  18. Genereux P, Giustino G, Witzenbichler B, Weisz G, Stuckey TD, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri E, Yadav M, Francese DP, Palmerini T, Kirtane AJ, Litherland C, Mehran R, Stone GW (2015) Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention. J Am Coll Cardiol 66:1036–1045

    Article  Google Scholar 

  19. Shimizu A, Sonoda S, Muraoka Y, Setoyama K, Inoue K, Miura T, Anai R, Sanuki Y, Miyamoto T, Oginosawa Y, Tsuda Y, Araki M, Otsuji Y (2019) Bleeding and ischemic events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients. J Cardiol 73:470–478

    Article  Google Scholar 

  20. Ndrepepa G, Berger PB, Mehilli J, Seyfarth M, Neumann FJ, Schomig A, Kastrati A (2008) Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol 51:690–697

    Article  Google Scholar 

  21. Lindsey JB, Marso SP, Pencina M, Stolker JM, Kennedy KF, Rihal C, Barsness G, Piana RN, Goldberg SL, Cutlip DE, Kleiman NS, Cohen DJ, Registry Investigators EVENT (2009) Prognostic impact of periprocedural bleeding and myocardial infarction after percutaneous coronary intervention in unselected patients: results from the EVENT (evaluation of drug-eluting stents and ischemic events) registry. JACC Cardiovasc Interv 2:1074–1082

    Article  Google Scholar 

  22. Boccardo P, Remuzzi G, Galbusera M (2004) Platelet dysfunction in renal failure. Semin Thromb Hemost 30:579–589

    Article  CAS  Google Scholar 

  23. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K (2015) An overview of regular dialysis treatment in Japan (as of 31 December 2013). Ther Apher Dial 19:540–574

    Article  CAS  Google Scholar 

  24. Montalescot G, Brieger D, Dalby AJ, Park SJ, Mehran R (2015) Duration of dual antiplatelet therapy after coronary stenting: a review of the evidence. J Am Coll Cardiol 66:832–847

    Article  Google Scholar 

  25. Chen YT, Chen HT, Hsu CY, Chao PW, Kuo SC, Ou SM, Shih CJ (2017) Dual antiplatelet therapy and clinical outcomes after coronary drug-eluting stent implantation in patients on hemodialysis. Clin J Am Soc Nephrol 12:262–271

    Article  Google Scholar 

  26. Kuno T, Hirano K, Abe T, Imaeda S, Hashimoto K, Ryuzaki T, Yokokura S, Saito T, Yamazaki H, Tabei R, Kodaira M, Numasawa Y (2019) Trans-radial percutaneous coronary intervention for patients with severe chronic renal insufficiency and/or on dialysis. Heart Vessels 34:1412–1419

    Article  Google Scholar 

Download references

Acknowledgements

The authors are deeply grateful to the nursing staff, mechanical engineering staff, radiographers, and office administrators at Shonan Kamakura General Hospital.

Author information

Authors and Affiliations

  1. Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan

    Takahiro Hayashi, Koki Shishido, Shohei Yokota, Hirokazu Miyashita, Yuka Mashimo, Hiroaki Yokoyama, Takashi Nishimoto, Noriaki Moriyama, Tomoki Ochiai, Kazuki Tobita, Futoshi Yamanaka, Shingo Mizuno, Yutaka Tanaka, Masato Murakami, Saeko Takahashi & Shigeru Saito

Authors
  1. Takahiro Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koki Shishido
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shohei Yokota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirokazu Miyashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuka Mashimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroaki Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Nishimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noriaki Moriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoki Ochiai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuki Tobita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Futoshi Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shingo Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yutaka Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masato Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Saeko Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shigeru Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koki Shishido.

Ethics declarations

Conflict of interest

The authors declares that they have no competing interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayashi, T., Shishido, K., Yokota, S. et al. Impact of bleeding events after percutaneous coronary intervention in patients on hemodialysis. Heart Vessels 35, 1323–1330 (2020). https://doi.org/10.1007/s00380-020-01605-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01605-0

Keywords

Search

Navigation