Researchers: Michal Benderly¹, Israel Barbash², Ofra Kalter-Leibovici¹, Elad Maor²

Background: The volume of percutaneous coronary intervention is increasing. Post-procedure antiplatelet therapy related major bleeding lead to re-hospitalization and poor prognosis. Real-world data on long-term outcome predictors are scarce.

Objectives: To evaluate the association between coronary catheterization and re-hospitalization mortality and their predictors.

Method: A single center cohort (2007-2021) was followed-up through the Ministry of Health hospitalization and mortality registries. Predictors were identified with multivariable negative binomial and Cox proportional hazard models.

Findings: Over a median of 6 years, 77% of 20,897 patients were hospitalized and 5,263 died. Patients with ≥50% stenosis treated conservatively had higher age-adjusted rates/1,000 person years (PY) of re-hospitalization (472) and mortality (50) compared to patients undergoing revascularization (343 and 36, respectively) and patients with <50% stenosis (358 and 33, respectively). Following multivariable adjustment, conservative treatment was associated with a 1.47 times more days in hospital (95% CI: 1.32-1.65) and ש higher mortality risk (Hazard ratio [HR]=1.4; 95% CI: 1.24-1.61) than patients with <50% stenosis. Older age, Arab ethnicity, smoking, comorbidity, body mass index<18.5 and pre-procedure anticoagulant therapy were associated with a higher hospitalization burden and mortality, while a history of ischemic heart disease and weight above the normal range were protective.
Significant bleeding occurred in 10% of patients. The adjusted risk of bleeding increased with post-procedure anticoagulant therapy (HR=1.45; 95% CI: 0.99-2.12), and the combination of aspirin with Coumadin (2.21; 1.65-2.98) or direct oral anticoagulants (1.56; 1.19-2.07) compared to no treatment. Older age, male sex, comorbidity (particularly chronic kidney disease), or underweight were associated with increased bleeding risk.

Conclusions: Patients with significant stenosis undergoing revascularization have a similar risk of re-hospitalization and mortality as patients with <50%.

Recommendations: The higher rates of adverse post-procedure outcomes among patients treated conservatively suggest the need for better risk-stratification based on national data.

Research end date: 12/2025