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Prognostic value of access site and nonaccess site bleeding after percutaneous coronary intervention: a cohort study

Wouter J Kikkert1, Ronak Delewi1, Dagmar M Ouweneel1

  • 1Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.

JACC. Cardiovascular Interventions
|May 20, 2014
PubMed

Insights

Access site bleeding (ASB) after ST-segment elevation myocardial infarction (STEMI) does not increase mortality risk. However, non-access site bleeding (non-ASB) is linked to higher risks of death and stent thrombosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • The prognostic implications of access site bleeding (ASB) following ST-segment elevation myocardial infarction (STEMI) remain a subject of clinical debate.
  • Understanding complications after primary percutaneous coronary intervention (PCI) is crucial for patient management.

Purpose of the Study:

  • To evaluate the prognostic significance of access site bleeding (ASB) versus non-access site bleeding (non-ASB) for adverse ischemic events and mortality in STEMI patients.
  • To clarify the association between bleeding complications and long-term outcomes after primary PCI.

Main Methods:

  • A cohort of 2,002 STEMI patients undergoing primary PCI was analyzed for 1-year outcomes.
  • Outcomes assessed included mortality, recurrent myocardial infarction (MI), stent thrombosis, and stroke.
  • A meta-analysis of existing studies on ASB and non-ASB in PCI patients was also conducted.

Main Results:

  • ASB occurred in 6.3% of patients and was not significantly associated with increased 1-year mortality, recurrent MI, stent thrombosis, or stroke.
  • Non-ASB was independently linked to a higher risk of 1-year mortality (HR: 2.77) and stent thrombosis (HR: 3.10).
  • The meta-analysis of nearly 500,000 patients confirmed that non-ASB is associated with a greater adjusted risk of subsequent 1-year mortality compared to ASB.

Conclusions:

  • In STEMI patients treated with primary PCI, ASB does not appear to significantly impact 1-year clinical outcomes.
  • Non-ASB is a significant independent predictor of 1-year mortality and stent thrombosis.
  • The findings suggest that non-ASB, rather than ASB, carries a greater prognostic burden for mortality after PCI in STEMI.
Abstract

Keywords:
ST-segment elevation myocardial infarctionmajor bleedingpercutaneous coronary interventionprimary percutaneous coronary interventionvascular access site

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