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Higher post procedural bleeding in patients with advanced chronic kidney disease undergoing percutaneous coronary
Mohammad Reza Movahed1,2, Sina Aghdasi1, Mehrtash Hashemzadeh2
1University of Arizona Sarver Heart Center, College of Medicine Tucson, AZ, USA.
Insights
Patients with advanced chronic kidney disease (ACKD) undergoing percutaneous coronary intervention (PCI) face higher bleeding risks. This study confirms ACKD independently increases post-PCI bleeding complications, even as overall rates decline.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Advanced chronic kidney disease (ACKD) is prevalent in patients undergoing percutaneous coronary intervention (PCI).
- Post-PCI bleeding is a significant predictor of mortality, posing a challenge in ACKD patients.
- Existing research often excludes ACKD patients, limiting understanding of their specific risks.
Purpose of the Study:
- To investigate the association between ACKD and post-PCI bleeding complications.
- To compare bleeding rates in ACKD patients versus those without ACKD undergoing PCI.
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database from 2006-2011.
- Inclusion of patients over 40 undergoing PCI, identified using ICD-9 CM codes.
- Comparison of post-PCI bleeding rates between ACKD (CKD stage 3+) and control groups.
Main Results:
- Out of 49,192 patients with post-PCI bleeding, 7.5% had ACKD.
- ACKD patients were older (mean age 68.7 years).
- ACKD was independently associated with increased post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001) after multivariate adjustment.
Conclusions:
- Advanced chronic kidney disease is an independent risk factor for post-PCI bleeding.
- Despite a general decrease in bleeding rates, ACKD patients remain at higher risk.
- Further research and risk mitigation strategies are warranted for ACKD patients undergoing PCI.
Background:
Advanced chronic kidney disease (ACKD) is common in patients undergoing percutaneous coronary intervention (PCI). Post-PCI bleeding has been shown to increase mortality and remains an important challenge in these patients. Previous studies have shown increased post-PCI bleeding in CKD patients but often ACKD patients are excluded from these trials. The goal of this study was to evaluate if patients undergoing PCI with advanced renal disease have higher bleeding complications.
Methods:
We analyzed the National Inpatient Sample (NIS) database to compare the post-PCI bleeding rates for ACKD (CKD stage 3 and above) undergoing PCI between 2006 and 2011 to those without ACKD in patients over the age of 40. Specific ICD-9 CM codes were used to identify these patients.
Results:
A total of 49,192 patients had post-PCI bleeding during the study period of which 3,675 (7.5%) had ACKD. Patients with ACKD were older (68.7±11.7 years). During the study period, there was a decline in post-PCI bleeding rates in both ACKD and control groups. Patients with ACKD have significantly higher post-PCI bleeding rates compared to the control group. For example, in 2006, 133.9 in patients with ACKD had bleeding vs. 104.4 per 100,000 in patients without ACKD (P<0.05). After multivariate adjustment for bassline comorbidities, ACKD remained independently associated with post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001).
Conclusion:
Despite the overall decline in post-PCI bleeding in patients undergoing PCI, ACKD remains independently associated with post-procedural bleeding.
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