Blood Draws, Fluid Input, and Bleeding Events After Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Clinical Quality Metrics

Background:

• The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry uses bleeding events within 72 hours of percutaneous coronary intervention (PCI) as a quality metric.
• It is unknown if markers of patient care intensity, such as fluid input and laboratory phlebotomy, influence these reported post-PCI bleeding events.

Purpose of the Study:

• To investigate the relationship between fluid volume input, number of laboratory draws, and post-PCI bleeding events.
• To assess if these care intensity markers improve the predictive ability of bleeding risk models.

Main Methods:

• A patient-level observational study of 13,553 PCI procedures was conducted.
• Multivariable logistic regression analyzed associations between bleeding events, fluid input, and lab draws up to 72 hours post-PCI.
• The improvement in discriminatory ability of a bleeding risk model was assessed by adding these variables.

Main Results:

• A total of 767 (5.7%) bleeding events were recorded.
• Increased fluid input and a higher number of lab draws were independently associated with increased odds of bleeding.
• A multivariable model incorporating fluid input and lab draws significantly improved predictive ability (C-statistic 0.927) compared to baseline characteristics alone (C-statistic 0.858).

Conclusions:

• Factors reflecting patient care intensity, specifically fluid administration and frequency of lab draws, significantly enhance the prediction of NCDR post-PCI bleeding events.
• Risk adjustment for lab draws and fluid intake should be considered when nationally reporting bleeding event rates.