• Tetsuo Furukawa, Isamu Mizote, Tatsuya Shiraki, Daisuke Nakamura, Mayu Nishio, Naoki Fukushima, Takashi Kitao, Kensuke Yokoi, Masahiro Kumada, Motoaki Kitagawa, Kunihiko Nagai, Kiyoshi Kume, Keiji Hirooka, Tsutomu Nakagawa, Tohru Ohama, Mitsuyoshi Takahara, Shungo Hikoso, and Yasushi Sakata.
• Department of Cardiology, Ikeda Municipal Hospital, Japan.
• Intern. Med. 2024 Nov 8.

AbstractBackground Recent guidelines recommend dual antiplatelet therapy (DAPT) for six months following percutaneous coronary intervention (PCI) in patients with chronic coronary disease, as unexpected hospitalization can trigger DAPT discontinuation. This study evaluated the predictive factors for unexpected hospitalization within six months after PCI in patients with chronic coronary disease. Methods This prospective multicenter study included 412 patients who underwent PCI for chronic coronary disease. Unexpected hospitalization was defined as a prolonged hospital stay, unscheduled readmission, and all-cause mortality. The predictive factors for unexpected hospitalization within six months post-PCI were evaluated using the Cox regression model. Results The rate of unexpected hospitalization 6 months after PCI was 10.8%±1.5%. Unexpected hospitalizations due to bleeding events accounted for 12.1% (n=5/41), whereas non-bleeding readmissions accounted for 87.9% (n=36/41). A multivariable analysis revealed that the number of Academic Research Consortium for High Bleeding Risk (ARC-HBR) major criteria met [adjusted hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.05-2.29; P=0.026], body weight (adjusted HR, 2.44; 95% CI 1.33-4.49; P=0.004), and presence of diabetes mellitus (adjusted HR, 1.94; 95% CI 1.09-3.47; P=0.025) were independent risk factors for unexpected hospitalization. Among the major ARC-HBR criteria, oral anticoagulant use (adjusted HR, 2.39; 95% CI, 1.14-5.02, P=0.021) and active malignancy (adjusted HR, 3.85; 95% CI, 1.47-10.05; P=0.006) were significantly associated with unexpected hospitalization after adjusting for a low body weight and diabetes mellitus. Conclusions The majority of unexpected hospitalizations after PCI in patients with chronic coronary disease are attributed to non-bleeding causes. The assessment using major ARC-HBR criteria in these patients not only addresses bleeding risks but also underscores its predictive value in conjunction with a low body weight and diabetes mellitus for the prediction of unexpected hospitalization.

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