Incidence and predictors of bleeding in ACS patients treated with PCI and prasugrel or ticagrelor: An analysis from the RENAMI registry.

To evaluate "real life" incidence and independent predictors of major bleeding defined in ACS patients treated with PCI and current standard antithrombotic therapy with prasugrel or ticagrelor. The RENAMI project is a multicenter retrospective observational registry enrolling 4424 patients with ACS treated with PCI and prasugrel or ticagrelor plus aspirin. Primary endpoint was MACE (major adverse cardiovascular events). Secondary endpoints included each component of MACE, cardiovascular death (CV death), recurrence of ACS (reACS) and stroke. Eighty three (1.8%) patients developed out of hospital major bleedings after 14.1 ± 6.2 months. These patients had higher rates of MACE (14.5% vs 4.4%; p = 0.001) and of all-cause death (11% vs 2.1%; p < 0.001). Independent predictors of major bleeding were age >75 years (OR 2.00; 95% CI 1.18-3.41; p = 0.010) and female sex (OR 1.66; 95% CI 1.02-2.70; p = 0.041). BARC 3-5 bleeding was independently associated with all-cause mortality (OR 3.46; 95% CI 1.64-7.31; p 0.001). In ACS patients treated with PCI and ticagrelor or prasugrel, BARC 3-5 bleedings despite being uncommon negatively impacted on prognosis. Old and female patients are at increased risk, offering clinical indications for tailoring dual antiplatelet therapy.

D'Ascenzo F ，Grosso A ，Abu-Assi E ，Kinnaird T ，Ariza-Solé A ，Manzano-Fernández S ，Templin C ，Velicki L ，Xanthopoulou I ，Cerrato E ，Rognoni A ，Boccuzzi G ，Omedè P ，Montabone A ，Taha S ，Durante A ，Gili S ，Ali HH ，Magnani G ，Autelli M ，Blanco PF ，Garay A ，Quadri G ，Marra WG ，Varbella F ，Queija BC ，Paz RC ，Fernández MC ，Pousa IM ，Gallo D ，Morbiducci U ，Dominguez-Rodriguez A ，Valdés M ，Cequier A ，Alexopoulos D ，Iñiguez-Romo A ，Gaita F ，Raposeiras-Roubin S ... -  《-》

Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries.

Peyracchia M ，Saglietto A ，Biolè C ，Raposeiras-Roubin S ，Abu-Assi E ，Kinnaird T ，Ariza-Solé A ，Liebetrau C ，Manzano-Fernández S ，Boccuzzi G ，Henriques JPS ，Wilton SB ，Velicki L ，Xanthopoulou I ，Correia L ，Rognoni A ，Fabrizio U ，Nuñez-Gil I ，Montabone A ，Taha S ，Fujii T ，Durante A ，Gili S ，Magnani G ，Autelli M ，Grosso A ，Kawaji T ，Blanco PF ，Garay A ，Quadri G ，Queija BC ，Huczek Z ，Paz RC ，González-Juanatey JR ，Fernández MC ，Nie SP ，D'Amico M ，Pousa IM ，Kawashiri MA ，Gallo D ，Morbiducci U ，Dominguez-Rodriguez A ，Lopez-Cuenca A ，Cequier A ，Alexopoulos D ，Iñiguez-Romo A ，Grossomarra W ，Usmiani T ，Rinaldi M ，D'Ascenzo F ... -  《-》

Long versus short dual antiplatelet therapy in acute coronary syndrome patients treated with prasugrel or ticagrelor and coronary revascularization: Insights from the RENAMI registry.

D'Ascenzo F ，Bertaina M ，Fioravanti F ，Bongiovanni F ，Raposeiras-Roubin S ，Abu-Assi E ，Kinnaird T ，Ariza-Solé A ，Manzano-Fernández S ，Templin C ，Velicki L ，Xanthopoulou I ，Cerrato E ，Rognoni A ，Boccuzzi G ，Omedè P ，Montabone A ，Taha S ，Durante A ，Gili S ，Magnani G ，Autelli M ，Grosso A ，Blanco PF ，Garay A ，Quadri G ，Varbella F ，Queija BC ，Paz RC ，Fernández MC ，Pousa IM ，Gallo D ，Morbiducci U ，Dominguez-Rodriguez A ，Valdés M ，Cequier A ，Alexopoulos D ，Iñiguez-Romo A ，Gaita F ，Rinaldi M ，Lüscher TF ... -  《-》

Usefulness of the PARIS Score to Evaluate the Ischemic-hemorrhagic Net Benefit With Ticagrelor and Prasugrel After an Acute Coronary Syndrome.

The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry. Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARISischemic and PARIShemorrhagic). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events. During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARISischemic and PARIShemorrhagic scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk. In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.

Raposeiras-Roubín S ，Caneiro Queija B ，D'Ascenzo F ，Kinnaird T ，Ariza-Solé A ，Manzano-Fernández S ，Templin C ，Velicki L ，Xanthopoulou I ，Cerrato E ，Quadri G ，Rognoni A ，Boccuzzi G ，Montabone A ，Taha S ，Durante A ，Gili S ，Magnani G ，Autelli M ，Grosso A ，Flores Blanco P ，Garay A ，Varbella F ，Tomassini F ，Cobas Paz R ，Cespón Fernández M ，Muñoz Pousa I ，Gallo D ，Morbiducci U ，Domínguez-Rodríguez A ，Baz-Alonso JA ，Calvo-Iglesias F ，Valdés M ，Cequier Á ，Gaita F ，Alexopoulos D ，Íñiguez-Romo A ，Abu-Assi E ... -  《-》

Prasugrel or ticagrelor in patients with acute coronary syndrome and diabetes: a propensity matched substudy of RENAMI.

Conrotto F ，Bertaina M ，Raposeiras-Roubin S ，Kinnaird T ，Ariza-Solé A ，Manzano-Fernández S ，Templin C ，Velicki L ，Xanthopoulou I ，Cerrato E ，Rognoni A ，Boccuzzi G ，Omedè P ，Montabone A ，Taha S ，Durante A ，Gili S ，Magnani G ，Autelli M ，Grosso A ，Flores Blanco P ，Garay A ，Quadri G ，Varbella F ，Caneiro Queija B ，Cobas Paz R ，Cespón Fernández M ，Muñoz Pousa I ，Gallo D ，Morbiducci U ，Dominguez-Rodriguez A ，Valdés M ，Cequier A ，Alexopoulos D ，Iñiguez-Romo A ，Gaita F ，Abu-Assi E ，D'Ascenzo F ... -  《-》