Observation of Bleeding and MACCE Events in Patients with Liver Cirrhosis Complicated with Acute Coronary Syndrome after Antiplatelet Therapy.

Objective: To evaluate the efficacy and safety of dual antiplatelet therapy (DATP) in subjects with Child-pugh class A cirrhosis complicated with acute coronary syndrome (ACS) after coronary Drug-eluting stent (DES) implantation.

Study design: Observational study. Place and Duration of the Study: Department of Cardiology, Beijing You 'an Hospital, Capital Medical University, China, from January to August 2021.

Methodology: Cirrhotic patients with ACS after DES were divided into an early cirrhosis group (n=90) and a non-cirrhosis group (n=66). They underwent monthly follow-ups for 12 months, and DATP was administered with acetylsalicylic acid and clopidogrel in standard doses. The endpoints included efficacy endpoints (Major Adverse Cardiovascular and Cerebrovascular Events, MACCE) and safety endpoints (bleeding events). Endpoint events were calculated. Cox regression model and Kaplan-Meier survival curve were used to analyse the correlation between the two groups.

Results: The overall frequency of five indicators was higher in the early cirrhosis group, including increased heart rate (HR), abnormal renal function, abnormal liver function, thrombocytopenia, and coronary multivessel disease (84.5% vs. 51.6%, all p<0.05). Kaplan-Meier survival analysis showed no significant difference between early cirrhosis and non-cirrhosis groups (p=0.688 for MACCE, p=0.960 for bleeding events). Multivariate Cox regression analysis also showed no statistical difference between the early cirrhosis group and the non-cirrhosis group (p=0.642 for MACCE, p=0.720 for bleeding events).

Conclusion: In patients of ACS with early cirrhosis, 12 months of DAPT may be effectively and safely reduced MACCE after implantation of DES.

Key words: Acute coronary syndrome, Liver cirrhosis, Dual antiplatelet therapy, Major adverse cardiovascular and cerebrovascular events.