Bleeding Severity in Percutaneous Coronary Intervention (PCI) and Its Impact on Short-Term Clinical Outcomes
Shashank Murali1, Sara Vogrin2, Samer Noaman1,3,4
1Department of Medicine, University of Melbourne, Melbourne 3010, Victoria, Australia.
Insights
Bleeding severity after percutaneous coronary intervention (PCI) is linked to worse outcomes. Reducing bleeding events, through strategies like radial access, may improve patient safety and reduce major adverse cardiac and cerebrovascular events (MACCE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Bleeding severity in percutaneous coronary intervention (PCI), defined by Bleeding Academic Research Consortium (BARC) criteria, is associated with adverse prognosis.
- Understanding the link between bleeding severity and major adverse cardiac and cerebrovascular events (MACCE) is crucial for patient management.
Purpose of the Study:
- To investigate the association between increasing BARC bleeding severity and in-hospital and 30-day MACCE in patients undergoing PCI.
- To identify independent predictors of major bleeding (BARC groups 3&5) and MACCE.
Main Methods:
- Analysis of data from 37,866 Australian patients undergoing PCI, enrolled in the Victorian Cardiac Outcomes Registry (VCOR).
- Assessment of the association between BARC bleeding severity and MACCE (mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, or stroke).
- Identification of independent predictors for major bleeding and MACCE using statistical analysis.
Main Results:
- A stepwise increase in in-hospital and 30-day MACCE was observed with greater bleeding severity.
- Independent predictors of bleeding included female sex, older age, fibrinolytic therapy, femoral access, and ticagrelor use.
- BARC 3&5 bleeds were independently predictive of cumulative in-hospital and 30-day MACCE (OR 4.37) after adjustment.
Conclusions:
- Major bleeding is an infrequent but potentially fatal complication of PCI.
- Bleeding is independently associated with increased MACCE rates, highlighting the importance of bleeding avoidance.
- Mitigating bleeding through radial access and judicious antiplatelet therapy may reduce short-term adverse outcomes.
Abstract:
Bleeding severity in patients undergoing percutaneous coronary intervention (PCI), defined by the Bleeding Academic Research Consortium (BARC), portends adverse prognosis. We analysed data from 37,866 Australian patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR), and investigated the association between increasing BARC severity and in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (a composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, or stroke). Independent predictors associated with major bleeding (BARC groups 3&5), and MACCE were also assessed. There was a stepwise increase in in-hospital and 30-day MACCE with greater severity of bleeding. Independent predictors of bleeding included female sex (Odds Ratio (OR) 1.34), age (OR 1.02), fibrinolytic therapy (OR 1.77), femoral access (OR 1.51), and ticagrelor (OR 1.42), all significant at the p < 0.001 level. Following adjustment of clinically important variables, BARC 3&5 bleeds (OR 4.37) were still predictive of cumulative in-hospital and 30-day MACCE. In conclusion, major bleeding is an uncommon but potentially fatal PCI complication and was independently associated with greater MACCE rates. Efforts to mitigate the occurrence of bleeding, including radial access and judicious use of potent antiplatelet therapies, may ameliorate the risk of short-term adverse clinical outcomes.
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