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Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the
Frederick Feit1, Michele D Voeltz, Michael J Attubato
1Department of Medicine, New York University School of Medicine, New York, NY, USA. frederick.feit@med.nyu.edu
Insights
Major hemorrhage is a significant risk for patients undergoing percutaneous coronary intervention (PCI). Factors like age, gender, and specific treatments predict bleeding, which independently increases mortality risk after PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemorrhagic Complications
Background:
- Patients undergoing percutaneous coronary intervention (PCI) face a substantial risk of hemorrhagic complications.
- Predictors of major hemorrhage and its association with mortality following PCI are not well-established.
Purpose of the Study:
- To identify baseline and periprocedural predictors of major hemorrhage in patients undergoing PCI.
- To determine the impact of major hemorrhage on mortality in PCI patients.
Main Methods:
- Analysis of data from the REPLACE-2 Trial involving 6,001 patients undergoing elective or urgent PCI.
- Random assignment to heparin plus glycoprotein IIb/IIIa inhibitor (GPI) or bivalirudin plus provisional GPIs.
- Statistical analysis to identify independent predictors of major hemorrhage and its association with mortality.
Main Results:
- 3.2% of patients experienced major hemorrhage.
- Independent baseline predictors included advanced age, female gender, impaired creatinine clearance, and anemia.
- Periprocedural predictors included heparin plus GPI treatment, longer procedure duration, provisional GPI use, delayed sheath removal, longer ICU stay, and intra-aortic balloon pump use.
- Major hemorrhage was independently associated with significantly higher 30-day, 6-month, and 1-year mortality rates (p <0.001).
Conclusions:
- Major hemorrhage is an independent predictor of 1-year mortality in patients undergoing PCI.
- Several baseline and periprocedural factors, including the use of heparin plus GPI, independently predict major hemorrhage.
- Identifying and mitigating these risk factors may improve outcomes for PCI patients.
Abstract:
Patients undergoing percutaneous coronary intervention (PCI) have a significant risk of hemorrhagic complications. Predictors of major hemorrhage and its relation to mortality in PCI are not well defined. Baseline and periprocedural predictors of major hemorrhage and its impact on mortality in patients undergoing elective or urgent PCI randomly assigned to heparin plus planned glycoprotein IIb/IIIa inhibitor (GPI) versus bivalirudin plus provisional GPIs in the REPLACE-2 Trial were determined. Of 6,001 patients, 3.2% experienced a major hemorrhage. Independent baseline predictors of major hemorrhage included advanced age, female gender, impaired creatinine clearance, and anemia. Independent periprocedural predictors of major hemorrhage included treatment with heparin plus GPI, increased procedural duration, provisional use of GPI, increased time to sheath removal, length of intensive care unit stay, and use of an intra-aortic balloon pump (all p <0.05). Mortality rates were higher in patients with than without major hemorrhage at 30 days (5.1% vs 0.2%), 6 months (6.7% vs 1.0%), and 1 year (8.7% vs 1.9%; p <0.001 for all). Furthermore, major hemorrhage was an independent predictor of 1-year mortality (odds ratio 2.66, 95% confidence interval 1.44 to 4.92, p = 0.002). In conclusion, in patients undergoing elective or urgent PCI, major hemorrhage was an independent predictor of 1-year mortality. A number of baseline and periprocedural factors independently predicted major hemorrhage, including treatment with heparin plus GPI.
