Percutaneous coronary intervention pharmacology - From a triangle to a square

In this issue of the Journal Ndrepepa et al. (1) present a meta-analysis of 4 ISAR (Intracoronary Stenting and Antithrombotic Regimen) percutaneous coronary intervention (PCI) trials suggesting that bleeding complications and myocardial infarction (MI) are equivalent predictors of 1-year mortality after PCI. Among 5,384 ISAR patients with a broad spectrum of coronary syndromes and risk, bleeding in the first 30 days after PCI conferred a nearly 3-fold increased risk of dying at 1 year. The end points of 30-day bleeding, MI, and urgent revascularization had a comparable ability to predict 1-year death. These results are congruent with analyses of the REPLACE-2 (Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events) trial comparing PCI using bivalirudin versus heparm and glycoprotem Ilb/IIIa inhibitor (GPI); patients with major bleeding had a similar relative risk of 1-year mortality (2.66, 95% confidence interval 1.44 to 4.92) as did those with MI (2.46, 95% confidence interval 1.44 to 4.20) (2).