{"id":"22318fd53b65","type":"article","url":"https://hartvaat.nl/2024/12/10/ernstige-bloeding-en-mortaliteit-na-revascularisatie-van-linker-hoofdstam/","title":"Ernstige bloeding en mortaliteit na revascularisatie van linker hoofdstam","title_en":"Major Bleeding and Mortality After Revascularization of Left Main Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","ouderen","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.07.065","source_url":"https://doi.org/10.1016/j.jacc.2024.07.065","authors":["Gennaro Giustino","Joseph F Sabik","Patrick W Serruys","John D Puskas","Dimitri Karmpaliotis","David E Kandzari","Marie-Claude Morice","Michael Ragosta","Zixuan Zhang","Ovidiu Dressler","Bjorn Redfors","Ori Ben-Yehuda","Samin K Sharma","Arie Pieter Kappetein","Gregg W Stone"],"significance":6,"published":"2024-12-10","source_date":"2024-12-10","image":"","kennis":[],"congress":"","summary_en":"This analysis documented the incidence and prognostic impact of major bleeding after left main revascularization, showing that bleeding complications significantly increase mortality for both PCI and CABG approaches.","created":"2026-07-03T10:31:22Z","updated":"2026-07-03T13:30:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse documenteerde het effect van majeure bloedingen op mortaliteit na revascularisatie van linker hoofdstamziekte. Bloedingscomplicaties zijn sterk geassocieerd met overlijden, wat bloedingspreventiestrategieën cruciaal maakt.","abstract_original":"BACKGROUND: The incidence and prognostic 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. OBJECTIVES: The goal of this study was to investigate the rates and outcomes of MB after LMCAD revascularization. METHODS: In the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed up for 5 years. MB was defined as TIMI major or minor bleeding, BARC (Bleeding Academic Research Consortium) types 3 to 5 bleeding, or any overt bleeding requiring blood transfusion. The association between MB and subsequent mortality was assessed in time-adjusted Cox regression models. RESULTS: At 5 years, 217 patients (11.4%) had at least 1 MB event. Rates of 5-year MB were 7.9% after PCI vs 14.8% after CABG (OR: 0.48; 95% CI: 0.36-0.65; P < 0.0001). However, in-hospital MB was lower after PCI (3.8% vs 13.5%; OR: 0.25; 95% CI: 0.17-0.37), whereas postdischarge MB was lower after CABG (4.5% vs 2.0%; OR: 2.33; 95% CI: 1.33-3.09; Pinteraction < 0.0001). All 41 postdischarge MB events after PCI occurred in patients receiving dual antiplatelet therapy. MB events within 5 years were associated with a higher subsequent risk of all-cause mortality (adjusted HR: 2.71; 95% CI: 1.95-3.77; P < 0.0001), whether in-hospital or postdischarge (Pinteraction = 1.00) and after both PCI and CABG (Pinteraction = 0.95), driven both by increased cardiovascular and non-cardiovascular mortality. CONCLUSIONS: In the EXCEL trial, CABG resulted in higher 5-year rates of all MB and in-hospital MB, although postdischarge MB was more frequent after PCI. MB after both procedures was associated with increased cardiovascular and noncardiovascular mortality within 5 years. (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)."}