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Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention
Insights
Major bleeding after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients is linked to adverse outcomes. Advanced age, female gender, anemia, and heart failure predict bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited data on bleeding complications in real-world ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- Existing research often focuses on acute coronary syndromes (ACS) from randomized trials, not unselected STEMI populations.
Purpose of the Study:
- To determine the incidence of in-hospital major bleeding in unselected STEMI patients undergoing primary PCI.
- To identify predictors of major bleeding in this patient group.
- To evaluate the prognostic impact of major bleeding on mortality and major adverse cardiac events (MACE).
Main Methods:
- Retrospective analysis of 770 consecutive STEMI patients undergoing primary PCI.
- Definition of major bleeding based on Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria.
- Assessment of in-hospital and 6-month mortality and MACE as primary outcomes.
Main Results:
- In-hospital major bleeding occurred in 4.2% of patients.
- Predictors included advanced age (≥65 years), female gender, baseline anemia, elevated white blood cell count, and congestive heart failure (Killip class II-IV).
- Major bleeding was associated with >2.5-fold higher mortality and MACE rates; it predicted 6-month MACE but not fully adjusted mortality/MACE.
Conclusions:
- Certain patient characteristics (advanced age, female gender, anemia, heart failure) identify high-risk individuals for bleeding post-primary PCI.
- While bleeding is linked to adverse outcomes and may indicate patient frailty, it's not an independent predictor of mortality or MACE in fully adjusted models.
Background/Aim:
Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI.
Methods:
All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE) in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE.
Results:
Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2%) patients. Independent pre-dictors of major bleeding were advanced age (≥ 65 years), female gender, baseline anemia and elevated white blood cell (WBC) count and signs of congestive heart failure at admission (Killip class II-IV). In-hospital and 6 month mortality and MACE, rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was predictor of 6-month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for OR 1.20-7.61; p = 0.019) but was not a true independent predictor of MACE and mortality in the fully adjusted models.
Conclusion:
Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at particularly high risk of bleeding after primary PCI. Bleeding is associated with adverse outcome and may be an important marker of patient frailty, but it is not a true independent predictor of mortality/MACE.
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