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Published on: March 15, 2022
Incidence and predictors of bleeding complications after percutaneous coronary intervention
Yohei Numasawa1, Shun Kohsaka2, Ikuko Ueda2
1Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan.
Insights
Bleeding complications after percutaneous coronary intervention (PCI) occur in about 3% of Japanese patients. Predictors include patient characteristics, clinical presentation, and technical factors, aiding risk assessment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Bleeding complications are a major challenge in percutaneous coronary intervention (PCI).
- Japanese patients may be more vulnerable to antiplatelet and anticoagulant therapies.
- Limited data exists on bleeding complication incidence and predictors in Japan.
Purpose of the Study:
- To investigate the incidence and independent predictors of bleeding complications after PCI in Japan.
- To develop and assess risk prediction models for bleeding events.
Main Methods:
- Analysis of 13,075 consecutive patients from a Japanese multicenter PCI registry (JCD-KiCS).
- Multivariate logistic regression to identify independent predictors.
- Development of three risk prediction models incorporating patient characteristics, clinical presentation, and angiographic/technical factors.
- Model discrimination assessed using the area under the receiver operating curve (AUC).
Main Results:
- The overall incidence of bleeding complications was 3.1% (402 patients).
- Independent predictors included age, female gender, previous PCI, heart failure, hemodialysis, myocardial infarction types, cardiogenic shock, transradial intervention, intra-aortic balloon pump, rotablator use, and chronic total occlusion PCI.
- Previous PCI and transradial intervention were inverse predictors of bleeding.
- Model AUCs were 0.667 (Model 1), 0.747 (Model 2), and 0.791 (Model 3), showing improved predictability with more variables.
Conclusions:
- The incidence of bleeding complications in Japanese PCI patients is approximately 3%, comparable to international registries.
- Patient characteristics, clinical presentation, and angiographic/technical factors are independent predictors of bleeding.
- Risk prediction models incorporating these factors demonstrate increasing accuracy.
Background:
Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan.
Methods:
We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC).
Results:
Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively.
Conclusions:
The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.
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