High Coronary artery calcium score linked to bleeding risk after PCI in chronic coronary syndrome

A new study published in Heart and Vessels Journal suggests that in chronic coronary syndrome (CCS) patients, a high coronary artery calcium (CAC) score is substantially related with the occurrence of severe bleeding events following percutaneous coronary intervention (PCI).

Antithrombotic medication significantly avoids acute coronary events in individuals with coronary artery disease (CAD), but at the expense of heightened worries about bleeding consequences. Hence, balancing thrombotic & bleeding risks during antithrombotic medication needs information on their risk stratifications. In light of this, numerous bleeding risk ratings based on basic clinical data have already been presented. The connection between coronary artery calcium and bleeding episodes during percutaneous coronary intervention in individuals with chronic coronary syndrome is unknown.

As a result, Soichi Komaki and colleagues undertook this study to evaluate the relationship between the CAC score derived by multidetector computed tomography (MDCT) and the risk of bleeding in patients with chronic coronary syndrome.

The 295 patients scheduled for their first elective PCI who received multidetector computer tomography as part of this retrospective observational analysis. Based on the CAC scores, patients were divided into two groups (low: 400 or high: >400). The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were used to assess the bleeding risk. The main clinical result was a significant bleeding incident within a year of PCI, which was categorized as a BARC 3 or 5 event.

The key findings of this study were:

Patients who met the ARC-HBR criteria made up a greater percentage in the high CAC score group than in the low CAC score group (52.7% vs. 31.3%, p 0.001) 

By comparing groups with different CAC scores, Kaplan-Meier survival analysis revealed that the incidence of severe bleeding episodes was greater in the high CAC score group (p 0.001). 

Additionally, a high CAC value was an independent predictor of significant bleeding episodes within the first year following PCI, according to multivariate Cox regression analysis.

In conclusion, after PCI, the incidence of severe bleeding events was substantially correlated with a high CAC score in CCS patients.

Reference: 

Komaki, S., Ishii, M., Kaichi, R., Takae, M., Mori, T., Toida, R., Kurogi, K., Matsuura, Y., Yamamoto, N., Tsujita, K., Tsuruda, T., & Kaikita, K. (2023). Relationship between coronary artery calcium score and bleeding events after percutaneous coronary intervention in chronic coronary syndrome. In Heart and Vessels. Springer Science and Business Media LLC. https://doi.org/10.1007/s00380-023-02248-7