Photo Credit: photovs

The following is a summary of “Major Bleeding and Mortality After Revascularization of Left Main Disease,” published in the December 2024 issue of Cardiology by Giustino et al.  

The incidence and impact of major bleeding (MB) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.  

Researchers conducted a prospective study to investigate the rates and outcomes of MB after revascularization for LMCAD.  

They conducted the EXCEL trial (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization), in which 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed for 5 years. The MB was defined as Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding, BARC (Bleeding Academic Research Consortium) types 3-5 bleeding, or any overt bleeding requiring transfusion. Time-adjusted Cox regression models assessed the association between MB and mortality.  

The results showed 217 patients (11.4%) experienced at least 1 MB event in 5 years. The rate of 5-year MB was 7.9% for PCI vs. 14.8% for CABG (OR: 0.48; 95% CI: 0.36-0.65; P<0.0001). In-hospital MB occurred less often with PCI (3.8% vs. 13.5%; OR: 0.25; 95% CI: 0.17-0.37), while post-discharge MB was more frequent after CABG (4.5% vs. 2.0%; OR: 2.33; 95% CI: 1.33-3.09; P_interaction < 0.0001). All post-discharge MB events after PCI occurred in patients receiving dual antiplatelet therapy. MB events during 5 years were associated with higher all-cause mortality (hazard ratio [HR]: 2.71; 95% CI: 1.95-3.77; P<0.0001), with increased cardiovascular and non-cardiovascular mortality (P_interaction = 1.00). The effect of MB on mortality was consistent after both PCI and CABG (P_interaction = 0.95).  

They concluded that MB after PCI and CABG for LMCAD was associated with higher mortality, with CABG showing higher rates of all MB and in-hospital events.  

Source: jacc.org/doi/10.1016/j.jacc.2024.07.065