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Impact on long-term mortality of access and non-access site bleeding after primary percutaneous coronary intervention

Dragan M Matic1, Milika R Asanin1, Vladan D Vukcevic2

  • 1Emergency Department, Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Heart (British Cardiac Society)
|May 27, 2019
PubMed

Insights

Bleeding after primary percutaneous coronary intervention (PCI) increases mortality. Non-access site bleeding poses a higher risk for very late mortality compared to access site bleeding in patients undergoing primary PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • The impact of bleeding location on long-term survival post-primary percutaneous coronary intervention (PCI) is not well understood.
  • Access site bleeding versus non-access site bleeding may have differential effects on patient outcomes.

Purpose of the Study:

  • To investigate the association between in-hospital bleeding at the access site versus non-access site and very late mortality in patients treated with primary PCI.
  • To determine if the bleeding site influences long-term survival after primary PCI.

Main Methods:

  • Analysis of 2715 patients with ST-segment elevation myocardial infarction undergoing primary PCI, from a prospective registry.
  • Bleeding events classified using Bleeding Academic Research Consortium (BARC) criteria; primary outcome was 4-year mortality.

Main Results:

  • BARC type ≥2 bleeding occurred in 6.3% of patients, with access site bleeding in 3.8% and non-access site bleeding in 2.5%.
  • Four-year mortality was significantly higher in patients with any bleeding (36.3%) versus no bleeding (16.2%).
  • Non-access site bleeding was associated with a 2-fold higher risk of very late mortality compared to access site bleeding.

Conclusions:

  • Both access and non-access site bleeding (BARC type ≥2) are independent predictors of 4-year mortality after primary PCI.
  • Non-access site bleeding confers a significantly higher risk of late mortality than access site bleeding.
Abstract

Keywords:
acute myocardial infarctionpercutaneous coronary intervention

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