Association between bleeding events and in-hospital mortality after percutaneous coronary intervention
Adnan K Chhatriwalla1, Amit P Amin, Kevin F Kennedy
1Department of Biostatistics, Saint Luke’sMid America HeartInstitute, Kansas City, Missouri 64111, USA.
Insights
Bleeding after percutaneous coronary intervention (PCI) significantly increases in-hospital mortality risk, accounting for 12.1% of deaths. This highlights the critical need for bleeding risk management in PCI patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Public Health
Background:
- Bleeding is a frequent complication following percutaneous coronary intervention (PCI).
- Post-PCI bleeding is linked to higher morbidity, increased healthcare costs, and unclear mortality associations.
- Nationally representative data on bleeding-related mortality after PCI are lacking.
Purpose of the Study:
- To investigate the association between bleeding events and in-hospital mortality after PCI.
- To estimate the population attributable risk, risk difference, and number needed to harm (NNH) for bleeding-related in-hospital mortality.
Main Methods:
- Analysis of 3,386,688 PCI procedures from the CathPCI Registry (2004-2011).
- Calculation of population attributable risk adjusted for demographic, clinical, and procedural variables.
- Propensity-matched analysis to determine NNH for bleeding-related mortality.
Main Results:
- Major bleeding occurred in 1.7% of PCI procedures, associated with a 12.1% population attributable risk for mortality.
- In a propensity-matched cohort, major bleeding increased in-hospital mortality (5.26% vs 1.87%, NNH=29).
- Both access-site and non-access-site bleeding increased mortality, with non-access bleeding having a lower NNH (16 vs 117).
Conclusions:
- Post-PCI bleeding events are significantly associated with increased in-hospital mortality.
- Approximately 12.1% of in-hospital deaths following PCI are attributable to bleeding complications.
- Effective bleeding risk management is crucial for improving outcomes in patients undergoing PCI.
Importance:
Bleeding is the most common complication after percutaneous coronary intervention (PCI) and is associated with increased morbidity and health care costs. The incidence of bleeding-related mortality after PCI has not been described in a nationally representative population. Furthermore, the relationships among bleeding risk, bleeding site, and mortality are unclear.
Objectives:
To describe the association between bleeding events and in-hospital mortality after PCI and to estimate the adjusted population attributable risk (estimated as the proportion of mortality risk associated with bleeding events), risk difference, and number needed to harm (NNH) for bleeding-related in-hospital mortality after PCI.
Design, Setting, And Patients:
Data from 3,386,688 procedures in the CathPCI Registry performed in the United States between 2004 and 2011 were analyzed. The population attributable risk was calculated after adjustment for baseline demographic, clinical, and procedural variables. To calculate the NNH for bleeding-related mortality, a propensity-matched analysis was performed.
Main Outcome Measures:
In-hospital mortality.
Results:
There were 57,246 bleeding events (1.7%) and 22,165 in-hospital deaths (0.65%) in 3,386,688 PCI procedures. The adjusted population attributable risk for mortality related to major bleeding was 12.1% (95% CI, 11.4%-12.7%) in the entire CathPCI cohort. The propensity-matched population consisted of 56,078 procedures with a major bleeding event and 224 312 controls. In this matched cohort, major bleeding was associated with increased in-hospital mortality (5.26% vs 1.87%; risk difference, 3.39% [95% CI, 3.20%-3.59%]; NNH = 29 [95% CI, 28-31]; P < .001). The association between major bleeding and in-hospital mortality was observed in all strata of preprocedural bleeding risk (low: 1.62% vs 0.17%; risk difference, 1.45% [95% CI, 1.13%-1.77%], NNH = 69 [95% CI, 57-88], P < .001; intermediate: 3.27% vs 0.71%; risk difference, 2.56% [95% CI, 2.33%-2.79%], NNH = 39 [95% CI, 36-43], P < .001; and high: 8.16% vs 3.45%; risk difference, 4.71% [95% CI, 4.35%-5.07%], NNH = 21 [95% CI, 20-23], P < .001). Although both access-site and non-access-site bleeding were associated with increased in-hospital mortality (2.73% vs 1.87%; risk difference, 0.86% [95% CI, 0.66%-1.05%], NNH = 117 [95% CI, 95-151], P < .001; and 8.25% vs 1.87%; risk difference, 6.39% [95% CI, 6.04%-6.73%], NNH = 16 [95% CI, 15-17], P < .001, respectively), the NNH was lower for nonaccess bleeding.
Conclusions And Relevance:
In a large registry of patients undergoing PCI, postprocedural bleeding events were associated with increased risk of in-hospital mortality, with an estimated 12.1% of deaths related to bleeding complications.
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