Association between bleeding events and in-hospital mortality after percutaneous coronary intervention

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.