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Prognostic implications of vascular complications following PCI

Robert Applegate1, Matthew Sacrinty, William Little

  • 1Wake Forest School of Medicine, Section of Cardiology, Medical Center Boulevard, Winston-Salem, North Carolina, USA. bapplega@wfubmc.edu

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 10, 2009
PubMed

Insights

Vascular complications after percutaneous coronary intervention (PCI) increase heart attack or death risk only when bleeding occurs. Without bleeding, these complications do not impact patient prognosis at one year.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Peri-procedural bleeding after PCI is linked to adverse outcomes.
  • The independent role of access site vascular complications (VC) in predicting 1-year outcomes is unclear.

Purpose of the Study:

  • To assess the impact of vascular complications (VC) on the adjusted risk of nonfatal myocardial infarction (MI) or death one year post-percutaneous coronary intervention (PCI).

Main Methods:

  • A cohort of 3,931 patients undergoing femoral access PCI was analyzed.
  • Post-procedural bleeding at access and non-access sites was assessed.
  • Cox proportional hazards modeling was used to evaluate the adjusted risk of VC association with 1-year outcomes.

Main Results:

  • Vascular complications occurred in 1.7% and TIMI bleeding in 6.7% of PCI procedures.
  • Initially, VC showed a trend towards increased risk of MI or death (HR 1.68).
  • However, after adjusting for TIMI bleeding, VC was no longer an independent predictor of adverse outcomes.

Conclusions:

  • Vascular complications following PCI independently predict adverse outcomes only if associated with TIMI major or minor bleeding.
  • Vascular complications without associated bleeding do not alter patient prognosis at one year.
Abstract

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