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Comparison of Bleeding Outcomes After Percutaneous Coronary Intervention in Patients With Versus Without Aortic
Christopher Huffman1, Rebecca Torguson1, Omid Fatemi1
1Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Patients with aortic stenosis (AS) face higher bleeding risks during percutaneous coronary intervention (PCI). However, the NCDR PCI Bleeding Risk Score adequately accounts for these risks, driven by comorbidities, not AS itself.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Aortic stenosis (AS) is linked to increased bleeding risk.
- Bleeding during percutaneous coronary intervention (PCI) in AS patients is not well understood.
- Transcutaneous aortic valve implantation era highlights the need to clarify AS-related bleeding risks.
Purpose of the Study:
- To assess bleeding risk during PCI in patients with moderate to severe aortic stenosis.
- To determine if aortic stenosis independently contributes to bleeding events post-PCI.
- To evaluate the predictive performance of the NCDR PCI Bleeding Risk Score in AS patients.
Main Methods:
- Retrospective study of 7,926 patients undergoing PCI (2004-2013).
- Patients categorized by presence of moderate/severe AS (n=354) vs. mild/no AS (n=7,572).
- Primary outcome: NCDR definition of bleeding event; NCDR PCI Bleeding Risk Score used for risk adjustment.
Main Results:
- Patients with AS had higher NCDR PCI Bleeding Risk Scores and bleeding rates.
- NCDR PCI Bleeding Risk Score predicted bleeding outcomes.
- Aortic stenosis did not independently predict bleeding events; adding AS to the score did not improve prediction (p=0.71).
Conclusions:
- The NCDR PCI Bleeding Risk Score effectively adjusts for bleeding risks in patients with aortic stenosis.
- Increased bleeding complications in AS patients post-PCI are primarily due to baseline comorbidities, not the stenosis itself.
Abstract:
Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS.
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