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Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
Michael J Thibert1,2, Christopher B Fordyce1,2, John A Cairns1,2
1Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Major bleeding in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) is linked to mortality. Non-access-site bleeding, not access-site bleeding, independently predicts worse in-hospital outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Major bleeding (MB) is a significant predictor of mortality in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (pPCI).
- While access-site bleeding prevention is prioritized, the distinct impacts of access-site versus non-access-site MB on in-hospital outcomes in STEMI patients undergoing pPCI require further investigation.
Purpose of the Study:
- To compare the association of access-site MB versus non-access-site MB with adverse in-hospital outcomes in STEMI patients undergoing pPCI.
- To evaluate the effectiveness of bleeding-avoidance strategies in reducing MB in this patient population.
Main Methods:
- A cohort of 1494 STEMI patients undergoing pPCI between 2012 and 2018 was analyzed.
- Patients were categorized into no MB, access-site MB, and non-access-site MB groups.
- Multivariable regression models were used to assess the association between bleeding types and in-hospital clinical outcomes, including the impact of bleeding-avoidance strategies.
Main Results:
- Major bleeding occurred in 8.1% of patients (3.2% access-site, 5.8% non-access-site).
- Non-access-site MB was independently associated with higher odds of in-hospital death (aOR 4.21), cardiogenic shock (aOR 10.91), and cardiac arrest (aOR 5.63).
- Access-site MB showed no significant association with adverse in-hospital outcomes. No specific bleeding-avoidance strategy significantly reduced MB after adjustment.
Conclusions:
- In STEMI patients undergoing pPCI, non-access-site MB is a significant independent predictor of adverse in-hospital outcomes.
- Access-site MB does not appear to be associated with increased in-hospital mortality or adverse events.
- Further research is needed to develop and implement strategies aimed at reducing the incidence and impact of non-access-site MB.
Background:
Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Prevention of access-site MB has received significant attention. However, limited data have been obtained on the influence of access-site MB vs non-access-site MB and association with subsequent adverse in-hospital outcomes in the STEMI population undergoing pPCI.
Methods:
We identified 1494 STEMI patients who underwent pPCI between 2012 and 2018. Unadjusted and adjusted differences among patients with no MB, access-site MB, non-access-site MB, and in-hospital clinical outcomes were assessed. The use of bleeding-avoidance strategies and their effects on MB were also evaluated.
Results:
MB occurred in 121 (8.1%) patients. Access-site MB occurred in 34 (2.3%) patients, and non-access-site MB occurred in 87 (5.8%). The median reduction in hemoglobin was 31 g/L (interquartile range: 19-43) with access-site MB, and 44 g/L (interquartile range: 29-62) with non-access-site MB. After multivariable adjustment, non-access-site MB was independently associated with in-hospital death (adjusted odds ratio [aOR] 4.21; 95% confidence interval [CI] 2.04-8.68), cardiogenic shock (aOR 10.91; 95% CI 5.67-20.98), and cardiac arrest (aOR 5.63; 95% CI 2.88-11.01). Conversely, access-site MB was not associated with adverse in-hospital outcomes. Bleeding-avoidance strategies were used frequently; however, after multivariable adjustment, no single bleeding-avoidance strategy was significantly associated with reduced MB.
Conclusions:
In STEMI patients undergoing pPCI, non-access-site MB was independently associated with adverse in-hospital outcomes, whereas access-site MB was not. Additional study of strategies to reduce the incidence and impact of non-access-site MB appears to be warranted.
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