Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and
Chun Shing Kwok1, Sunil V Rao2, Phyo K Myint3
1Cardiovascular Institute, University of Manchester , Manchester , UK.
Insights
Major bleeding after percutaneous coronary intervention (PCI) significantly increases mortality and major adverse cardiovascular events (MACEs). The definition of bleeding impacts mortality risk, with some definitions showing a 6.7-fold increase.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Periprocedural bleeding is a known complication of PCI.
- The impact of different bleeding definitions on patient outcomes requires further clarification.
Purpose of the Study:
- To investigate the association between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality following PCI.
- To compare the prognostic significance of various bleeding definitions in the context of PCI.
Main Methods:
- A systematic review and meta-analysis of studies evaluating periprocedural bleeding after PCI.
- Searched MEDLINE and EMBASE databases for relevant studies.
- Utilized random-effects meta-analysis to estimate the risk of adverse outcomes associated with bleeding.
Main Results:
- Analysis of 42 studies involving 533,333 patients.
- Periprocedural major bleeding independently increased mortality risk (OR 3.31) and MACEs (OR 3.89).
- Different bleeding definitions showed varying impacts on mortality, with REPLACE-2, STEEPLE, and BARC having the highest prognostic impact.
Conclusions:
- Major bleeding post-PCI is linked to a threefold increase in mortality and MACEs.
- The choice of bleeding definition significantly influences the observed mortality risk, ranging from 1.5-fold to 6.7-fold increases.
Objectives:
To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions.
Methods:
We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic.
Results:
42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes.
Conclusions:
Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.
