SUPPLEMENTARY MATERIAL
Supplementary Appendix A: List of participating centers and investigators for the
CREDO-Kyoto PCI/CABG Registry Cohort-2
Cardiology
Kyoto University Hospital: Takeshi Kimura
Kishiwada City Hospital: Mitsuo Matsuda, Hirokazu Mitsuoka
Tenri Hospital: Yoshihisa Nakagawa
Hyogo Prefectural Amagasaki Hospital: Hisayoshi Fujiwara, Yoshiki Takatsu, Ryoji Taniguchi
Kitano Hospital: Ryuji Nohara
Koto Memorial Hospital: Tomoyuki Murakami, Teruki Takeda
Kokura Memorial Hospital: Masakiyo Nobuyoshi, Masashi Iwabuchi
Maizuru Kyosai Hospital: Ryozo Tatami
Nara Hospital, Kinki University Faculty of Medicine: Manabu Shirotani
Kobe City Medical Center General Hospital: Toru Kita, Yutaka Furukawa, Natsuhiko Ehara
Nishi-Kobe Medical Center: Hiroshi Kato, Hiroshi Eizawa
Kansai Denryoku Hospital: Katsuhisa Ishii
1
Osaka Red Cross Hospital: Masaru Tanaka
University of Fukui Hospital: Jong-Dae Lee, Akira Nakano
Shizuoka City Shizuoka Hospital: Akinori Takizawa
Hamamatsu Rosai Hospital: Masaaki Takahashi
Shiga University of Medical Science Hospital: Minoru Horie, Hiroyuki Takashima
Japanese Red Cross Wakayama Medical Center: Takashi Tamura
Shimabara Hospital: Mamoru Takahashi
Kagoshima University Medica and Dental Hospital: Chuwa Tei, Shuichi Hamasaki
Shizuoka General Hospital: Hirofumi Kambara, Osamu Doi, Satoshi Kaburagi
Kurashiki Central Hospital: Kazuaki Mitsudo, Kazushige Kadota
Mitsubishi Kyoto Hospital: Shinji Miki, Tetsu Mizoguchi
Kumamoto University Hospital: Hisao Ogawa, Seigo Sugiyama
Shimada Municipal Hospital: Ryuichi Hattori, Takeshi Aoyama, Makoto Araki
Juntendo University Shizuoka Hospital: Satoru Suwa
Cardiovascular Surgery
2
Kyoto University Hospital: Ryuzo Sakata, Tadashi Ikeda, Akira Marui
Kishiwada City Hospital: Masahiko Onoe
Tenri Hospital: Kazuo Yamanaka
Hyogo Prefectural Amagasaki Hospital: Keiichi Fujiwara, Nobuhisa Ohno
Kokura Memorial Hospital: Michiya Hanyu
Maizuru Kyosai Hospital: Tsutomu Matsushita
Nara Hospital, Kinki University Faculty of Medicine: Noboru Nishiwaki, Yuichi Yoshida
Kobe City Medical Center General Hospital: Yukikatsu Okada, Michihiro Nasu
Osaka Red Cross Hospital: Shogo Nakayama
University of Fukui Hospital: Kuniyoshi Tanaka, Takaaki Koshiji, Koichi Morioka
Shizuoka City Shizuoka Hospital: Mitsuomi Shimamoto, Fumio Yamazaki
Hamamatsu Rosai Hospital: Junichiro Nishizawa
Japanese Red Cross Wakayama Medical Center: Masaki Aota
Shimabara Hospital: Takafumi Tabata
Kagoshima University Medica and Dental Hospital: Yutaka Imoto, Hiroyuki Yamamoto
Shizuoka General Hospital: Katsuhiko Matsuda, Masafumi Nara
3
Kurashiki Central Hospital: Tatsuhiko Komiya
Mitsubishi Kyoto Hospital: Hiroyuki Nakajima
Kumamoto University Hospital: Michio Kawasuji, Syuji Moriyama
Juntendo University Shizuoka Hospital: Keiichi Tanbara
Supplementary Appendix B: List of clinical research coordinators
Research Institute for Production Development
Kumiko Kitagawa, Misato Yamauchi, Naoko Okamoto, Yumika Fujino, Saori Tezuka, Asuka Saeki,
Miya Hanazawa, Yuki Sato, Chikako Hibi, Hitomi Sasae, Emi Takinami, Yuriko Uchida, Yuko
Yamamoto, Satoko Nishida, Mai Yoshimoto, Sachiko Maeda, Izumi Miki, Saeko Minematsu.
Supplementary Appendix C: List of clinical event committee members
Mitsuru Abe (Kyoto Medical Center), Hiroki Shiomi (Kyoto University Hospital), Tomohisa Tada
(Kyoto University Hospital), Junichi Tazaki (Kyoto University Hospital), Yoshihiro Kato (Kyoto
University Hospital), Mamoru Hayano (Kyoto University Hospital), Akihiro Tokushige (Kyoto
University Hospital), Masahiro Natsuaki (Kyoto University Hospital), Tetsu Nakajima (Kyoto
University Hospital).
4
Supplementary Tables
Supplementary Table 1. Univariate and Multivariable Effects of Clinically Relevant Factors
for Ischemic Events within 30 Days after Surgical Procedures in the AMI stratum
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
Early surgery (within 42 days)
28/153
15/586
7.58 (4.11-14.6)
<0.0001
5.65 (2.42-13.5)
<0.0001
DES use
13/242
30/497
0.89 (0.45-1.66)
0.7
1.30 (0.61-2.66)
0.5
General/Spinal anesthesia
19/290
24/432
1.19 (0.64-2.16)
0.6
2.64 (1.22-5.71)
0.01
No APT
13/347
20/334
0.62 (0.30-1.24)
0.2
0.66 (0.27-1.61)
0.4
Single APT
3/147
30/534
0.36 (0.09-1.00)
0.05
0.42 (0.09-1.37)
0.2
Age >= 75
26/244
17/495
3.19 (1.75-5.99)
0.0002
2.01 (0.96-4.28)
0.06
Male gender
29/553
14/186
0.69 (0.37-1.35)
0.3
BMI < 25.0
38/538
5/201
2.91 (1.26-8.45)
0.01
Multivessel disease
31/421
12/318
1.98 (1.04-4.01)
0.04
Mitral regurgitation grade 3/4
4/25
39/714
3.09 (0.93-7.66)
0.06
Prior myocardial infarction
2/28
41/711
1.26 (0.21-4.10)
0.8
Shock at presentation
19/155
24/584
3.08 (1.67-5.62)
0.0005
1.21 (0.54-2.62)
0.6
Heart failure
25/279
18/460
2.32 (1.27-4.32)
0.006
Stroke
6/75
37/664
1.49 (0.56-3.26)
0.4
Atrial fibrillation
6/78
37/661
1.41 (0.53-3.09)
0.5
COPD
2/28
41/711
1.23 (0.20-4.00)
0.8
Malignancy
8/90
35/649
1.64 (0.71-3.36)
0.2
Peripheral vascular disease
4/39
39/700
1.86 (0.56-4.61)
0.3
Hemodialysis
1/13
42/726
1.32 (0.07-6.05)
0.8
eGFR<30, not on hemodialysis
5/54
38/685
1.72 (0.59-3.98)
0.3
Hypertension
30/572
13/167
0.66 (0.35-1.32)
0.2
Current smoking
12/298
31/441
0.56 (0.28-1.06)
0.08
Insulin-treated diabetes
1/51
42/688
0.31 (0.02-1.44)
0.2
Anemia (Hb < 11.0g/dl)
9/94
34/645
1.85 (0.84-3.70)
0.1
Platelet <100*109/L*
1/16
42/723
1.04 (0.06-4.78)
1.0
20/416
23/323
0.66 (0.36-1.21)
0.2
Target of LMCA
8/34
35/705
5.06 (2.18-10.4)
0.0005
1.46 (0.45-3.97)
0.5
Target of CTO
2/27
41/712
1.30 (0.21-4.21)
0.7
Target of proximal LAD
5
p value
Multivariable
p value
H.R. (95%C.I.)
Target of bifurcation
15/199
28/540
1.46 (0.76-2.70)
0.2
1/33
42/706
0.51 (0.03-2.33)
0.5
Total stent length >=28mm
21/347
22/392
1.07 (0.59-1.95)
0.8
Minimal stent size < 3.0mm
18/258
25/481
1.35 (0.72-2.46)
0.3
Cilostazol
12/269
31/470
0.68 (0.34-1.29)
0.2
Statins
10/357
33/382
0.32 (0.15-0.62)
0.0005
0.63 (0.25-1.45)
0.3
ACE-I/ARB
18/506
25/233
0.32 (0.17-0.59)
0.0002
0.51 (0.24-1.06)
0.07
Beta blockers
8/310
35/429
0.31 (0.13-0.63)
0.0008
0.32 (0.12-0.78)
0.01
Calcium channel blockers
4/161
39/578
0.36 (0.11-0.90)
0.03
Nitrates
6/210
37/529
0.41 (0.15-0.89)
0.02
0.39 (0.13-0.94)
0.04
Nicorandil
9/233
34/506
0.56 (0.25-1.12)
0.1
Proton pump inhibitors
13/273
30/466
0.73 (0.37-1.37)
0.3
H2 blokers
9/217
34/522
0.63 (0.29-1.27)
0.2
Warfarin
2/81
41/658
0.40 (0.07-1.30)
0.1
Two-stent for bifurcation
Baseline medications
ACE-I=angiotensin converting enzyme inhibitor, APT=antiplatelet therapy, ARB=angiotensin
receptor blocker, BMI=body mass index, CI=confidence interval, COPD=chronic obstructive
pulmonary disease, CTO=chronic total occlusion, DES=drug-eluting stents, eGFR=estimated
glomerular filtration rate, Hb=hemoglobin, HR=hazard ratio, H2-blocker=histamine type 2 receptor
blocker, LAD=left anterior descending coronary artery, LMCA=left main coronary artery,
PCI=percutaneous coronary intervention,
and PPI=proton pump inhibitor.
6
Supplementary Table 2. Univariate and Multivariable Effects of Clinically Relevant Factors
for Ischemic Events within 30 Days after Surgical Procedures in the Non-AMI stratum
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
6/202
26/1457
1.67 (0.62-3.80)
0.3
1.52 (0.47-4.17)
0.5
DES use
24/1053
8/606
1.75 (0.82-4.16)
0.2
2.38 (0.90-7.56)
0.08
General/Spinal anesthesia
19/766
12/861
1.78 (0.88-3.78)
0.1
3.27 (1.32-8.53)
0.01
No APT
13/813
13/691
0.84 (0.39-1.83)
0.7
0.52 (0.20-1.43)
0.2
Single APT
2/297
24/1207
0.34 (0.05-1.14)
0.09
0.29 (0.04-1.20)
0.09
Age >= 75
13/595
19/1064
1.23 (0.59-2.47)
0.6
Male gender
24/1214
8/445
1.10 (0.52-2.62)
0.8
BMI < 25.0
26/1132
6/527
2.02 (0.89-5.44)
0.1
Multivessel disease
24/992
8/667
2.03 (0.95-4.83)
0.07
Mitral regurgitation grade 3/4
1/90
31/1569
0.55 (0.03-2.58)
0.5
Prior myocardial infarction
9/265
23/1394
2.07 (0.91-4.32)
0.08
0/0
32/1659
-
-
Heart failure
12/301
20/1358
2.73 (1.29-5.50)
0.01
2.29 (0.97-5.21)
0.06
Stroke
3/233
29/1426
0.64 (0.15-1.79)
0.4
Atrial fibrillation
5/169
27/1490
1.63 (0.55-3.89)
0.3
COPD
3/88
29/1571
1.86 (0.44-5.22)
0.3
Malignancy
5/258
27/1401
1.00 (0.34-2.40)
1.0
Peripheral vascular disease
4/309
28/1350
0.62 (0.18-1.58)
0.3
Hemodialysis
6/126
26/1533
2.87 (1.07-6.53)
0.04
eGFR<30, not on hemodialysis
3/112
29/1547
1.41 (0.34-3.98)
0.6
25/1430
7/229
0.57 (0.26-1.44)
0.2
Current smoking
7/417
25/1242
0.83 (0.33-1.81)
0.7
Insulin-treated diabetes
5/212
27/1447
1.26 (0.43-3.00)
0.6
Anemia (Hb < 11.0g/dl)
14/310
18/1349
3.41 (1.67-6.84)
0.001
2.45 (1.04-5.52)
0.04
1/22
31/1637
2.43 (0.14-11.3)
0.4
23/968
9/691
1.83 (0.87-4.17)
0.1
Target of LMCA
0/70
32/1589
-
0.1
Target of CTO
7/216
25/1443
1.89 (0.75-4.14)
0.2
Target of bifurcation
13/571
19/1088
1.31 (0.63-2.63)
0.5
2/86
30/1573
1.23 (0.20-4.06)
0.8
Early surgery (within 42 days)
Shock at presentation
Hypertension
Platelet <100*109/L*
Target of proximal LAD
Two-stent for bifurcation
7
p value
Multivariable
p value
H.R. (95%C.I.)
Total stent length >=28mm
17/847
15/812
1.09 (0.54-2.20)
0.8
Minimal stent size < 3.0mm
19/794
13/865
1.60 (0.80-3.32)
0.2
Cilostazol
3/183
29/1476
0.83 (0.20-2.33)
0.8
Statins
10/759
22/900
0.53 (0.24-1.10)
0.09
ACE-I/ARB
15/850
17/809
0.84 (0.41-1.68)
0.6
Beta blockers
9/410
23/1249
1.18 (0.52-2.48)
0.7
Calcium channel blockers
12/847
20/812
0.57 (0.27-1.15)
0.1
Nitrates
12/642
20/1017
0.96 (0.45-1.93)
0.9
Nicorandil
8/350
24/1309
1.24 (0.52-2.65)
0.6
Proton pump inhibitors
10/392
22/1267
1.47 (0.66-3.02)
0.3
H2 blokers
4/351
28/1308
0.53 (0.16-1.36)
0.2
Warfarin
6/143
26/1516
2.47 (0.92-5.62)
0.07
Baseline medications
ACE-I=angiotensin converting enzyme inhibitor, APT=antiplatelet therapy, ARB=angiotensin
receptor blocker, BMI=body mass index, CI=confidence interval, COPD=chronic obstructive
pulmonary disease, CTO=chronic total occlusion, DES=drug-eluting stents, eGFR=estimated
glomerular filtration rate, Hb=hemoglobin, HR=hazard ratio, H2-blocker=histamine type 2 receptor
blocker, LAD=left anterior descending coronary artery, LMCA=left main coronary artery,
PCI=percutaneous coronary intervention,
and PPI=proton pump inhibitor.
8
Supplementary Table 3. Univariate and Multivariable Effects of Early Surgery after PCI and
AMI Presentation for Ischemic Events within 30 Days after Surgical Procedures.
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
p value
Multivariable
p value
H.R. (95%C.I.)
Interaction (AMI/Early surgery)
0.03
Early surgery (within 42 days)
34/355
41/2043
4.91(3.10-7.72)
<0.0001
2.81(1.52-5.15)
0.001
DES use
37/1295
38/1103
0.83(0.53-1.31)
0.4
1.63(0.93-2.87)
0.09
General/Spinal anesthesia
38/1056
36/1293
1.30(0.82-2.05)
0.3
2.63(1.47-4.73)
0.001
No APT
26/1160
33/1025
0.69(0.41-1.15)
0.2
1.56(0.81-2.99)
0.2
Single APT
5/444
54/1741
0.36(0.13-0.82)
0.01
0.62(0.21-1.53)
0.3
Acute myocardial infarction
43/739
32/1659
3.08(1.96-4.91)
<0.0001
2.85(1.52-5.30)
0.001
Age >= 75
39/839
36/1559
2.03(1.29-3.21)
0.002
1.87(1.10-3.20)
0.02
Male gender
53/1767
22/631
0.86(0.53-1.44)
0.6
BMI < 25.0
64/1670
11/728
2.56(1.41-5.13)
0.001
Multivessel disease
55/1413
20/985
1.93(1.18-3.30)
0.008
2.13(1.16-4.17)
0.01
Mitral regurgitation grade 3/4
5/115
70/2283
1.41(0.50-3.17)
0.5
Prior myocardial infarction
11/293
64/2041
1.24(0.62-2.25)
0.5
Shock at presentation
19/155
56/2243
5.14(2.98-8.48)
<0.0001
1.39(0.65-2.90)
0.4
Heart failure
37/580
38/1818
3.10(1.97-4.88)
<0.0001
Stroke
9/308
66/2090
0.94(0.43-1.78)
0.9
Atrial fibrillation
11/247
64/2151
1.51(0.75-2.74)
0.2
COPD
5/116
70/2282
1.41(0.49-3.15)
0.5
Malignancy
13/348
62/2050
1.23(0.65-2.16)
0.5
Peripheral vascular disease
8/348
67/2050
0.69(0.31-1.36)
0.3
Hemodialysis
7/139
68/2259
1.70(0.71-3.44)
0.2
eGFR<30, not on hemodialysis
8/166
67/2232
1.61(0.71-3.15)
0.2
55/2002
20/396
0.54(0.33-0.92)
0.02
Hypertension
Interaction p
9
Current smoking
19/715
56/1683
0.79(0.46-1.31)
0.4
Insulin-treated diabetes
6/263
69/2135
0.70(0.27-1.48)
0.4
Anemia (Hb < 11.0g/dl)
23/404
52/1994
2.20(1.32-3.55)
0.003
2/38
73/2360
1.70(0.28-5.39)
0.5
43/1384
32/1014
0.98(0.62-1.56)
0.9
Target of LMCA
8/104
67/2294
2.67(1.18-5.23)
0.02
Target of CTO
9/243
66/2155
1.22(0.56-2.31)
0.6
Target of bifurcation
28/770
47/1628
1.26(0.78-2.00)
0.3
Two-stent for bifurcation
5/122
83/2321
0.80(0.20-2.14)
0.7
Total stent length >=28mm
38/1194
37/1204
1.03(0.66-1.63)
0.9
Minimal stent size < 3.0mm
37/1052
38/1346
1.25(0.79-1.97)
0.3
Cilostazol
15/452
60/1946
1.09(0.59-1.86)
0.8
Statins
20/1116
55/1282
0.41(0.24-0.68)
ACE-I/ARB
33/1356
42/1042
Beta blockers
17/720
Calcium channel blockers
1.71(0.94-3.02)
0.08
0.0003
0.47(0.24-0.85)
0.01
0.60(0.38-0.95)
0.03
0.59(0.34-1.00)
0.052
58/1678
0.68(0.38-1.13)
0.1
16/1008
59/1390
0.37(0.21-0.62)
0.0001
0.44(0.22-0.82)
0.009
Nitrates
18/852
57/1546
0.57(0.33-0.95)
0.03
Nicorandil
17/583
58/1815
0.90(0.51-1.52)
0.7
Proton pump inhibitors
23/665
52/1733
1.15(0.69-1.86)
0.6
H2 blokers
13/568
62/1830
0.68(0.36-1.19)
0.2
Warfarin
8/224
67/2174
1.17(0.52-2.30)
0.7
Platelet <100*109/L*
Target of proximal LAD
Baseline medications
ACE-I=angiotensin converting enzyme inhibitor, AMI=Acute myocardial infarction,
APT=antiplatelet therapy, ARB=angiotensin receptor blocker, BMI=body mass index, CI=confidence
interval, COPD=chronic obstructive pulmonary disease, CTO=chronic total occlusion,
DES=drug-eluting stents, eGFR=estimated glomerular filtration rate, Hb=hemoglobin, HR=hazard
10
ratio, H2-blocker=histamine type 2 receptor blocker, LAD=left anterior descending coronary artery,
LMCA=left main coronary artery, PCI=percutaneous coronary intervention, and PPI=proton pump
inhibitor.
11
Supplementary Table 4. Clinical Characteristics of Those Patients With Definite or Probable
Stent Thrombosis
Indication for PCI
The timing of surgery
Non-AMI
Early surgery
AMI
Late surgery
Early surgery
Late surgery
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6
Patient 7
Patient 8
Patient 9
70
64
73
71
73
50
52
55
64
Sex
Male
Female
Male
Female
Male
Male
Male
Male
Male
Hypertension
Yes
Yes
Yes
No
Yes
Yes
Yes
No
No
Diabetes Mellitus
Yes
No
Yes
No
Yes
No
No
No
No
Current smoking
Yes
Yes
No
No
No
No
Yes
Yes
No
eGFR<30, not on dialysis
No
No
No
No
No
No
No
No
No
Dialysis
No
No
No
No
No
No
No
No
No
SES and BMS
SES only
SES only
SES only
SES only
BMS only
BMS only
BMS only
Age (years)
SES and
Stent type
BMS
LVEF (%)
Unknown
63
46
49
50
58
65
48
40
3
1
2
2
3
3
1
1
1
Target of proximal LAD
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Target of unprotected LMCA
No
No
No
No
No
No
No
No
No
Target of CTO
Yes
No
No
Yes
No
No
No
No
No
Target of bifurcation
Yes
Yes
Yes
Yes
No
Yes
No
No
No
Side-branch stenting
Yes
No
No
No
No
Yes
No
No
No
Total number of stents
6
1
2
2
2
4
1
2
1
Total stent length (mm)
133
28
46
46
36
87
20
44
24
Minimum stent size (mm)
2.5
3
2.5
3
2.5
2.5
3.5
3
3.5
Days from PCI to Surgery
30
1107
70
703
1284
11
0
6
353
Gastrointestinal
Oral and
Gastrointestinal
Dermatologic
Orthopedic
Abdominal
Respiratory
Abdominal
endoscopy
maxillofacial
endoscopy
N of target lesions
Surgical Fields
Anesthesia
General/Spinal
Respiratory
General/Spinal
General/Spinal
General/Spinal
Local
General/Spinal
Local
Local
Local
No
No
No
No
Dual
Dual
Dual
No
Aspirin: 5
Aspirin: 7
Clopidogrel:
Ticlopidine:
11
708
Single
Status of perioperative APT
(Aspirin only)
Discontinuation interval
Unknown
Unknown
Aspirin: 4
Unknown
0
0
0
Ticlopidine:
before surgery (days)
ARC classification of ST
ST vessel
4
Definite
Definite
Definite
Definite
Probable
Definite
Definite
Definite
Probable
LCX
LAD
LCX
LAD
Unknown
LCX
RCA
LAD
LAD
12
Time from PCI to ST (days)
31
1114
78
704
1284
12
0
14
362
Time from Surgery to ST (days)
1
7
8
1
0
1
0
8
9
ST timing
Late
Very late
Late
Very late
Very Late
Subacute
Acute
Subacute
Late
Death within 30 days after surgery
No
No
No
No
Yes
No
No
No
Yes
Ischemic events related to ST
MI
MI
MI
MI
MI
MI
MI
UAP
MI
AMI=Acute myocardial infarction, APT=antiplatelet therapy, ARC=Academic Research Consortium,
BMS=bare-metal stent, CTO=chronic total occlusion, DES=drug-eluting stents, eGFR=estimated
glomerular filtration rate, LAD=left anterior descending coronary artery, LCX=left circumflex
coronary artery, LMCA=left main coronary artery, MI=myocardial infarction, PCI=percutaneous
coronary intervention, RCA=right coronary artery, SES=sirolimus-eluting stent, ST=stent
thrombosis, and UAP=unstable angina pectoris.
13
Supplementary Table 5. Univariate and Multivariable Effects of Clinically Relevant Factors
for Bleeding Events within 30 Days after Surgical Procedures in the AMI stratum
Variables
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
Early surgery (within 42 days)
13/153
11/586
5.05 (2.26-11.5)
0.0001
4.12 (1.66-10.3)
0.003
DES use
5/242
19/497
0.53 (0.18-1.33)
0.2
0.43 (0.14-1.12)
0.08
General/Spinal anesthesia
9/290
15/432
0.89 (0.37-1.99)
0.8
1.39 (0.54-3.40)
0.5
No APT
8/347
15/334
0.50 (0.20-1.15)
0.1
0.70 (0.22-2.14)
0.5
Single APT
5/147
18/534
0.97 (0.32-2.44)
1.0
1.31 (0.37-4.20)
0.7
Age >= 75
11/244
13/495
1.80 (0.79-4.02)
0.2
Male gender
18/553
6/186
0.99 (0.42-2.73)
1.0
BMI < 25.0
16/538
8/201
0.76 (0.33-1.88)
0.5
Multivessel disease
19/421
5/318
2.91 (1.17-8.79)
0.02
3.41 (1.32-10.5)
0.01
Mitral regurgitation grade 3/4
3/25
21/714
4.38 (1.03-12.7)
0.05
Prior myocardial infarction
1/28
23/711
1.08 (0.06-5.14)
0.9
Shock at presentation
10/155
14/584
2.80 (1.21-6.27)
0.02
Heart failure
14/279
10/460
2.37 (1.06-5.49)
0.04
Stroke
0/75
24/664
-
0.02
Atrial fibrillation
3/78
21/661
1.28 (0.30-3.72)
0.7
COPD
0/28
24/711
-
0.2
Malignancy
5/90
19/649
1.91 (0.63-4.75)
0.2
Peripheral vascular disease
2/39
22/700
1.66 (0.27-5.64)
0.5
Hemodialysis
0/13
24/726
-
0.3
eGFR<30, not on hemodialysis
4/54
20/685
2.65 (0.77-7.00)
0.1
Hypertension
18/572
6/167
0.87 (0.37-2.40)
0.8
Current smoking
11/298
13/441
1.24 (0.54-2.77)
0.6
Insulin-treated diabetes
5/51
19/688
3.51 (1.16-8.72)
0.03
3.50 (1.14-8.96)
0.03
Anemia (Hb < 11.0g/dl)
5/94
19/645
1.88 (0.62-3.67)
0.2
Platelet <100*109/L*
1/16
23/723
2.10 (0.12-9.95)
0.5
15/416
9/323
1.32 (0.59-3.13)
0.5
Target of LMCA
4/34
20/705
4.43 (1.29-11.7)
0.02
2.18 (0.48-7.05)
0.3
Target of CTO
2/27
22/712
2.42 (0.39-8.22)
0.3
Target of bifurcation
9/199
15/540
1.69 (0.71-3.80)
0.2
Two-stent for bifurcation
1/33
23/706
0.94 (0.05-4.45)
0.9
Target of proximal LAD
14
p value
Multivariable
p value
H.R. (95%C.I.)
Total stent length >=28mm
15/347
9/392
1.89 (0.84-4.50)
0.1
Minimal stent size < 3.0mm
10/258
14/481
1.40 (0.60-3.13)
0.4
Cilostazol
6/269
18/470
0.57 (0.21-1.37)
0.2
Statins
8/357
16/382
0.52 (0.21-1.17)
0.1
ACE-I/ARB
14/506
10/233
0.63 (0.28-1.47)
0.3
Beta blockers
10/310
14/429
0.99 (0.43-2.21)
1.0
Calcium channel blockers
6/161
18/578
1.16 (0.42-2.78)
0.8
Nitrates
7/210
17/529
1.01 (0.39-2.35)
1.0
Nicorandil
5/233
19/506
0.55 (0.18-1.37)
0.2
Proton pump inhibitors
10/273
14/466
1.21 (0.52-2.70)
0.7
H2 blokers
4/217
20/522
0.47 (0.14-1.24)
0.1
Warfarin
2/81
22/658
0.74 (0.12-2.51)
0.7
Baseline medications
ACE-I=angiotensin converting enzyme inhibitor, APT=antiplatelet therapy, ARB=angiotensin
receptor blocker, BMI=body mass index, CI=confidence interval, COPD=chronic obstructive
pulmonary disease, CTO=chronic total occlusion, DES=drug-eluting stents, eGFR=estimated
glomerular filtration rate, Hb=hemoglobin,
HR=hazard ratio, H2-blocker=histamine type 2 receptor
blocker, LAD=left anterior descending coronary artery, LMCA=left main coronary artery,
PCI=percutaneous coronary intervention,
and PPI=proton pump inhibitor.
15
Supplementary Table 6. Univariate and Multivariable Effects of Clinically Relevant Factors
for Bleeding Events within 30 Days after Surgical Procedures in the Non-AMI stratum
Variables
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
9/202
27/1457
2.46 (1.09-5.04)
0.03
1.83 (0.75-4.17)
0.2
DES use
22/1053
14/606
0.91 (0.47-1.82)
0.8
0.76 (0.36-1.65)
0.5
General/Spinal anesthesia
23/766
12/861
2.14 (1.09-4.46)
0.03
2.28 (1.04-5.20)
0.04
No APT
19/813
14/691
1.13 (0.57-2.30)
0.7
0.63 (0.27-1.52)
0.3
Single APT
2/297
31/1207
0.26 (0.04-0.85)
0.02
0.25 (0.04-0.98)
0.05
Age >= 75
14/595
22/1064
1.14 (0.57-2.21)
0.7
Male gender
22/1214
14/445
0.58 (0.30-1.15)
0.1
BMI < 25.0
26/1132
10/527
1.22 (0.61-2.65)
0.6
Multivessel disease
24/968
12/655
1.36 (0.69-2.81)
0.4
Mitral regurgitation grade 3/4
5/90
31/1569
2.87 (0.98-6.75)
0.05
Prior myocardial infarction
8/265
28/1394
1.52 (0.65-3.18)
0.3
Shock at presentation
36/1659
0/0
-
-
Heart failure
16/301
20/1358
3.68 (1.88-7.10)
0.0002
2.77 (1.31-5.73)
0.009
Stroke
9/233
27/1426
2.07 (0.92-4.24)
0.08
Atrial fibrillation
4/169
32/1490
1.10 (0.33-2.77)
0.9
COPD
1/88
35/1571
0.51 (0.03-2.35)
0.5
Malignancy
3/258
33/1401
0.49 (0.12-1.36)
0.2
Peripheral vascular disease
10/309
26/1350
1.68 (0.77-3.37)
0.2
Hemodialysis
9/126
27/1533
4.24 (1.88-8.68)
0.001
3.02 (1.23-6.69)
0.02
eGFR<30, not on hemodialysis
3/112
33/1547
1.25 (0.30-3.49)
0.7
Hypertension
34/1430
2/229
2.73 (0.83-16.8)
0.1
Current smoking
11/417
25/1242
1.31 (0.62-2.60)
0.5
Insulin-treated diabetes
11/212
25/1447
3.01 (1.42-5.96)
0.005
Anemia (Hb < 11.0g/dl)
11/310
25/1349
1.96 (0.93-3.88)
0.08
0/22
36/1637
-
0.3
22/968
14/691
1.12 (0.58-2.24)
0.7
Target of LMCA
3/70
33/1589
2.08 (0.50-5.79)
0.3
Target of CTO
4/216
32/1443
0.84 (0.25-2.11)
0.7
Target of bifurcation
15/571
21/1088
1.38 (0.70-2.65)
0.4
1/86
35/1573
0.53 (0.03-2.45)
0.5
Early surgery (within 42 days)
Platelet <100*109/L*
Target of proximal LAD
Two-stent for bifurcation
16
p value
Multivariable
p value
H.R. (95%C.I.)
Total stent length >=28mm
19/847
17/812
1.07 (0.55-2.08)
0.8
Minimal stent size < 3.0mm
16/794
20/865
0.87 (0.45-1.68)
0.7
Cilostazol
5/183
31/1476
1.30 (0.44-3.06)
0.6
Statins
19/759
17/900
1.31 (0.68-2.54)
0.4
ACE-I/ARB
20/850
16/809
1.18 (0.62-2.32)
0.6
Beta blockers
13/410
23/1249
1.72 (0.85-3.34)
0.1
Calcium channel blockers
19/847
17/812
1.07 (0.55-2.07)
0.8
Nitrates
12/642
24/1017
0.79 (0.38-1.55)
0.5
Nicorandil
13/350
23/1309
2.10 (1.03-4.08)
0.04
Proton pump inhibitors
10/392
26/1267
1.24 (0.57-2.49)
0.6
H2 blokers
8/351
28/1308
1.06 (0.45-2.22)
0.9
Warfarin
4/143
32/1516
1.32 (0.39-3.34)
0.6
Baseline medications
2.01 (0.95-4.06)
0.07
ACE-I=angiotensin converting enzyme inhibitor, APT=antiplatelet therapy, ARB=angiotensin
receptor blocker, BMI=body mass index, CI=confidence interval, COPD=chronic obstructive
pulmonary disease, CTO=chronic total occlusion, DES=drug-eluting stents, eGFR=estimated
glomerular filtration rate, Hb=hemoglobin,
HR=hazard ratio, H2-blocker=histamine type 2 receptor
blocker, LAD=left anterior descending coronary artery, LMCA=left main coronary artery,
PCI=percutaneous coronary intervention,
and PPI=proton pump inhibitor.
17
Supplementary Table 7. Univariate and Multivariable Effects of Early Surgery after PCI and
AMI Presentation for Bleeding Events within 30 Days after Surgical Procedures.
Variables
Present
Absent
Univariate
N of events /N of patients
N of events /N of patients
H.R. (95%C.I.)
p value
Multivariable
p value
H.R. (95%C.I.)
Interaction (AMI/Early surgery)
0.3
Early surgery (within 42 days)
22/355
38/2043
3.53(2.06-5.91)
<0.0001
2.34(1.27-4.23)
0.007
DES use
27/1295
33/1103
0.69(0.41-1.15)
0.2
0.60(0.34-1.06)
0.08
General/Spinal anesthesia
32/1056
27/1293
1.44(0.86-2.42)
0.2
1.87(1.04-3.39)
0.04
No APT
27/1160
29/1025
0.80(0.47-1.36)
0.4
1.56(0.78-3.05)
0.2
Single APT
7/444
49/1741
0.55(0.23-1.14)
0.1
0.93(0.36-2.06)
0.9
Acute myocardial infarction
24/739
36/1659
1.53(0.90-2.55)
0.1
Age >= 75
25/839
35/1559
1.35(0.80-2.24)
0.3
Male gender
40/1767
20/631
0.71(0.42-1.24)
0.2
BMI < 25.0
42/1670
18/728
1.03(0.60-1.83)
0.9
Multivessel disease
43/1413
17/985
1.78(1.04-3.21)
0.04
Mitral regurgitation grade 3/4
8/115
52/2283
3.14(1.38-6.24)
0.009
1.87(0.75-3.99)
0.2
Prior myocardial infarction
9/293
51/2105
1.27(0.58-2.45)
0.5
Shock at presentation
10/155
50/2243
3.05(1.46-5.75)
0.005
Heart failure
30/580
30/1818
3.22(1.94-5.36)
<0.0001
2.09(1.18-3.66)
0.01
Stroke
9/308
51/2090
1.21(0.56-2.34)
0.6
Atrial fibrillation
7/247
53/2151
1.16(0.48-2.39)
0.7
COPD
1/116
59/2282
0.33(0.02-1.51)
0.2
Malignancy
8/348
52/2050
0.90(0.39-1.78)
0.8
Peripheral vascular disease
12/348
48/2050
1.47(0.74-2.67)
0.3
Hemodialysis
9/139
51/2259
2.97(1.36-5.73)
0.008
eGFR<30, not on hemodialysis
7/166
53/2232
1.79(0.74-3.69)
0.2
52/2002
8/396
1.28(0.65-2.92)
0.5
Hypertension
Interaction p
18
Current smoking
22/715
38/1683
1.36(0.79-2.28)
0.3
Insulin-treated diabetes
16/263
44/2135
2.94(1.61-5.10)
0.00008
Anemia (Hb < 11.0g/dl)
16/404
44/1994
1.84(1.01-3.19)
0.047
1/38
59/2360
1.09(0.06-4.95)
0.9
37/1384
23/1014
1.18(0.71-2.02)
0.5
Target of LMCA
7/104
53/2294
2.99(1.24-6.14)
0.02
Target of CTO
6/243
54/2155
0.98(0.38-2.11)
1
Target of bifurcation
24/770
36/1628
1.43(0.84-2.39)
0.2
Two-stent for bifurcation
2/119
58/2279
0.67(0.11-2.13)
0.5
Total stent length >=28mm
34/1194
26/1204
1.32(0.79-2.21)
0.3
Minimal stent size < 3.0mm
26/1052
34/1346
0.99(0.59-1.65)
1
Cilostazol
11/452
49/1946
0.97(0.48-1.79)
0.9
Statins
27/1116
33/1282
0.92(0.55-1.53)
0.8
ACE-I/ARB
34/1356
26/1042
1.00(0.60-1.68)
1
Beta blockers
23/720
37/1678
1.45(0.85-2.43)
0.2
Calcium channel blockers
25/1008
35/1390
0.97(0.57-1.61)
0.9
Nitrates
19/852
41/1546
0.83(0.47-1.41)
0.5
Nicorandil
18/583
42/1815
1.32(0.74-2.25)
0.3
Proton pump inhibitors
20/665
40/1733
1.30(0.75-2.20)
0.3
H2 blokers
12/568
48/1830
0.80(0.40-1.45)
0.5
Warfarin
6/224
54/2174
1.08(0.42-2.31)
0.9
Platelet <100*109/L*
Target of proximal LAD
3.17(1.70-5.66)
0.0005
2.25(0.84-5.04)
0.1
Baseline medications
ACE-I=angiotensin converting enzyme inhibitor, AMI=Acute myocardial infarction,
APT=antiplatelet therapy, ARB=angiotensin receptor blocker, BMI=body mass index, CI=confidence
interval, COPD=chronic obstructive pulmonary disease, CTO=chronic total occlusion,
DES=drug-eluting stents, eGFR=estimated glomerular filtration rate, Hb=hemoglobin, HR=hazard
19
ratio, H2-blocker=histamine type 2 receptor blocker, LAD=left anterior descending coronary artery,
LMCA=left main coronary artery, PCI=percutaneous coronary intervention, and PPI=proton pump
inhibitor.
20
Supplementary Table 8. Relation between bleeding and timing of surgery.
Within 7 days
8 to 30 days
Number of patients
Bleeding locations
AMI
Non-AMI
AMI
Non-AMI
60
16
24
8
12
31 (51.6%)
10 (62.5%)
15 (62.5%)
1 (12.5%)
5 (41.7%)
15 (25.0%)
3 (18.8%)
3 (18.8%)
5 (62.5%)
4 (33.3%)
Intracranial hemorrhage
5 (8.3%)
1 (6.3%)
2 (8.3%)
1 (12.5%)
1 (8.3%)
Others
8 (13.3%)
2 (12.5%)
3 (12.5%)
1 (12.5%)
2 (16.7%)
Unknown
1 (1.7%)
0 (0.0%)
1 (4.2%)
0 (0.0%)
0 (0.0%)
(%)
All
Surgery-related bleeding
Gastrointestinal hemorrhage
AMI=Acute Myocardial Infarction.
21
Supplementary Table 9. Cumulative Incidence of Adverse Events at 30 days After Surgical
Procedures
Endpoints
N of events (incidence) at 30 days after surgery
AMI (STEMI and non-STEMI)
STEMI
Early surgery
Late surgery
p value
Early surgery
Late surgery
p value
28 (18.4%)
15 (2.6%)
<0.0001
22 (17.4%)
13 (2.7%)
<0.0001
25 (16.5%)
13 (2.3%)
<0.0001
19 (15.1%)
11 (2.3%)
<0.0001
MI
2 (1.3%)
3 (0.5%)
0.3
2 (1.6%)
3 (0.6%)
0.3
ST (definite or probable)
3 (2.0%)
1 (0.2%)
0.006
3 (2.5%)
1 (0.2%)
0.005
ST (definite)
3 (2.0%)
0 (0.0%)
0.0006
3 (2.5%)
0 (0.0%)
0.0005
Bleeding
13 (9.7%)
11 (2.0%)
<0.0001
12 (10.6%)
8 (1.7%)
<0.0001
Death/MI/ST (definite or
probable)
Death
Cumulative incidences were estimated by the Kaplan-Meier method.
AMI=Acute Myocardial Infarction, MI=myocardial infarction, and ST=stent thrombosis.
22