Association between periprocedural bleeding and long-term outcomes following percutaneous coronary intervention in
Sunil V Rao1, David Dai, Sumeet Subherwal
1Duke Clinical Research Institute, Durham, North Carolina 27705, USA. sunil.rao@duke.edu
Insights
Bleeding after percutaneous coronary intervention (PCI) increases the risk of recurrent bleeding, major adverse cardiac events (MACE), and mortality. Identifying strategies to reduce bleeding risk is crucial for patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Bleeding complications following percutaneous coronary intervention (PCI) are linked to increased acute morbidity and long-term mortality.
- The specific associations between post-PCI bleeding and subsequent adverse events remain incompletely understood.
Purpose of the Study:
- To investigate the association between post-procedural bleeding and long-term outcomes in older patients undergoing PCI.
- To determine the relationship between bleeding events and recurrent bleeding, major adverse cardiac events (MACE), and mortality.
Main Methods:
- Utilized data from the National Cardiovascular Data Registry (NCDR) CathPCI Registry (n=461,311) linked with Medicare claims.
- Patients were categorized based on in-hospital post-PCI bleeding.
- Cox regression analysis examined associations with 1-, 12-, and 30-month outcomes, adjusting for patient and procedural factors.
Main Results:
- 3.1% of patients experienced post-PCI bleeding.
- Bleeding patients were older, more often female, and had more comorbidities.
- Adjusted analysis revealed significant associations between post-PCI bleeding and increased risk of bleeding readmission, MACE, and all-cause mortality at 1, 12, and 30 months.
Conclusions:
- Post-PCI bleeding complications are significantly associated with increased risks of short- and long-term recurrent bleeding, MACE, and all-cause mortality.
- Periprocedural bleeding holds prognostic importance.
- Strategies to mitigate long-term bleeding risk in PCI patients are essential.
Objectives:
The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events (MACE), and mortality among older patients undergoing percutaneous coronary intervention (PCI).
Background:
Bleeding complications after PCI are associated with an increased risk for acute morbidity and long-term mortality, but the association of these bleeding complications with other events is unknown.
Methods:
Patients entered into the National Cardiovascular Data Registry (NCDR) CathPCI Registry (n = 461,311; 946 sites) from January 2004 to December 2008 were linked with claims from the Centers for Medicare & Medicaid Services and grouped according to in-hospital post-PCI bleeding. The association between post-PCI bleeding and 1-, 12-, and 30-month readmission for bleeding, MACE, and all-cause mortality was examined with Cox regression that included patient and procedural characteristics using no bleeding as the reference.
Results:
Overall, 3.1% (n = 14,107) of patients experienced post-PCI bleeding. Patients who bled were older, more often female, had more medical comorbidities, less often received bivalirudin, and more often underwent PCI via the femoral approach. After adjustment, bleeding after the index procedure was significantly associated with readmission for bleeding (adjusted hazard ratios [95% confidence interval]: 1 month, 1.54 [1.42 to 1.67]; 12 months, 1.52 [1.40 to 1.66]; 30 months, 1.29 [1.11 to 1.50]), MACE (1 month, 1.11 [1.07 to 1.15]; 12 months, 1.17 [1.13 to 1.21]; 30 months, 1.12 [1.06 to 1.19]) and all-cause mortality (1 month, 1.32 [1.26 to 1.38]; 12 months, 1.33 [1.27 to 1.40]); 30 months, 1.22 [1.15 to 1.30]).
Conclusions:
Post-PCI bleeding complications are associated with an increased risk for short- and long-term recurrent bleeding, MACE, and all-cause mortality. These data underscore the prognostic importance of periprocedural bleeding and the need for identifying strategies to reduce long-term bleeding risk among patients undergoing PCI.
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