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Incidence and correlates of major bleeding after percutaneous coronary intervention across different clinical
Joshua P Loh1, Lakshmana K Pendyala1, Rebecca Torguson1
1Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Insights
Bleeding after percutaneous coronary intervention (PCI) increases with disease severity. Patients with cardiogenic shock (CGS), ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI) face higher bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Post-procedural bleeding following percutaneous coronary intervention (PCI) is a significant predictor of mortality.
- Understanding bleeding incidence across diverse clinical presentations is crucial for risk stratification.
Purpose of the Study:
- To compare the incidence and correlates of bleeding after PCI among patients with varying clinical presentations.
- To identify specific patient groups at higher risk for bleeding post-PCI.
Main Methods:
- A large cohort study involving 23,943 consecutive PCI patients.
- Patients were categorized by clinical presentation: stable angina, unstable angina (UAP), NSTEMI, STEMI, and cardiogenic shock (CGS).
- Statistical analysis, including multivariable models, was used to assess bleeding risk and associated factors.
Main Results:
- Major bleeding rates increased with clinical severity: stable angina (0.7%) to CGS (13.5%).
- CGS, STEMI, and NSTEMI were independently associated with increased major bleeding risk (ORs 4.67, 3.39, 2.00, respectively).
- Factors like IABP use, female gender, heart failure, and longer procedure times correlated with bleeding.
Conclusions:
- Worsening clinical presentation severity directly correlates with higher post-PCI major bleeding rates.
- Elevated bleeding risk in CGS, STEMI, and NSTEMI patients persists even after adjusting for aggressive treatments.
- Close monitoring of antithrombotic therapy is essential in high-risk PCI populations.
Background:
Bleeding after percutaneous coronary intervention (PCI) is identified as a strong predictor for adverse events, including mortality. This study aims to compare the incidence and correlates of post-PCI bleeding across different clinical presentations.
Methods:
The study included 23,943 consecutive PCI patients categorized according to their clinical presentation: stable angina pectoris (n = 6,741), unstable angina pectoris (UAP) (n = 5,215), non-ST-segment elevation myocardial infarction (NSTEMI) (n = 8,418), ST-segment elevation myocardial infarction (STEMI) (n = 2,721), and cardiogenic shock (CGS) (n = 848).
Results:
Severity of clinical presentation was associated with a greater use of preprocedural anticoagulation, glycoprotein IIb/IIIa inhibitors, and intraaortic balloon pump (IABP). TIMI-defined major bleeding increased with increasing severity of clinical presentation: stable angina pectoris, 0.7%; UAP, 1.0%; NSTEMI, 1.6%; STEMI, 4.6%; and CGS, 13.5% (P < .001). On multivariable analysis, CGS (odds ratio [OR], 4.67; 95% CI [2.62-8.34]), STEMI (OR, 3.39; 95% CI [2.07-5.55]), and NSTEMI (OR, 2.00; 95% CI [1.29-3.10]) remained correlated with major bleeding even after adjusting for baseline and procedural differences, whereas UAP did not. The multivariable model also identified the use of IABP, female gender, congestive heart failure, no prior PCI, increased baseline hematocrit, and increased procedure time as correlates for major bleeding.
Conclusions:
In patients undergoing PCI, the worsening severity of clinical presentation corresponds to an increase in incidence of post-PCI major bleeding. The increased risk with CGS, STEMI, and NSTEMI persisted despite adjusting for more aggressive pharmacotherapy and use of IABP. Careful attention to antithrombotic pharmacotherapy is warranted in this high-risk population.
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