Intracranial Bleeding After Percutaneous Coronary Intervention: Time-Dependent Incidence, Predictors, and Impact on Mortality

Background Limited data are available on intracranial hemorrhage (ICH) in patients undergoing antithrombotic therapy after percutaneous coronary intervention (PCI). Methods and Results Using the Korean National Health Insurance Service database, we identified 219 274 patients without prior ICH and who underwent a first PCI procedure between 2007 and 2016 and analyzed nontraumatic ICH and all-cause mortality. ICH after PCI occurred in 4171 patients during a median follow-up of 5.6 years (overall incidence rate: 3.32 cases per 1000 person-years). The incidence rate of ICH showed an early peak of 21.66 cases per 1000 person-years within the first 30 days, followed by a sharp decrease to 3.68 cases per 1000 person-years between 30 days and 1 year, and to <1 case per 1000 patient-years from the second year until 10 years after PCI. The 1-year mortality rate was 38.2% after ICH, with most deaths occurring within 30 days (n=999, mortality rate: 24.2%). No significant difference in mortality risk was observed between patients who had ICH within and after 1 year following PCI (adjusted hazard ratio, 1.04; 95% CI, 0.95-1.14; P=0.43). The predictors of post-PCI ICH were age >= 75 years, hypertension, atrial fibrillation, end-stage renal disease, history of stroke or transient ischemic attack, dementia, and use of vitamin K antagonists. Conclusions New ICH most frequently occurs in the early period after PCI and is associated with a high risk of early death, regardless of the occurrence time of ICH. Careful implementation of antithrombotic strategies is needed in patients at an increased risk for ICH, particularly in the peri-PCI period.