Document Detail


Association between periprocedural bleeding and long-term outcomes following percutaneous coronary intervention in older patients.
MedLine Citation:
PMID:  22995883     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events (MACE), and mortality among older patients undergoing percutaneous coronary intervention (PCI).
BACKGROUND: Bleeding complications after PCI are associated with an increased risk for acute morbidity and long-term mortality, but the association of these bleeding complications with other events is unknown.
METHODS: Patients entered into the National Cardiovascular Data Registry (NCDR) CathPCI Registry (n = 461,311; 946 sites) from January 2004 to December 2008 were linked with claims from the Centers for Medicare & Medicaid Services and grouped according to in-hospital post-PCI bleeding. The association between post-PCI bleeding and 1-, 12-, and 30-month readmission for bleeding, MACE, and all-cause mortality was examined with Cox regression that included patient and procedural characteristics using no bleeding as the reference.
RESULTS: Overall, 3.1% (n = 14,107) of patients experienced post-PCI bleeding. Patients who bled were older, more often female, had more medical comorbidities, less often received bivalirudin, and more often underwent PCI via the femoral approach. After adjustment, bleeding after the index procedure was significantly associated with readmission for bleeding (adjusted hazard ratios [95% confidence interval]: 1 month, 1.54 [1.42 to 1.67]; 12 months, 1.52 [1.40 to 1.66]; 30 months, 1.29 [1.11 to 1.50]), MACE (1 month, 1.11 [1.07 to 1.15]; 12 months, 1.17 [1.13 to 1.21]; 30 months, 1.12 [1.06 to 1.19]) and all-cause mortality (1 month, 1.32 [1.26 to 1.38]; 12 months, 1.33 [1.27 to 1.40]); 30 months, 1.22 [1.15 to 1.30]).
CONCLUSIONS: Post-PCI bleeding complications are associated with an increased risk for short- and long-term recurrent bleeding, MACE, and all-cause mortality. These data underscore the prognostic importance of periprocedural bleeding and the need for identifying strategies to reduce long-term bleeding risk among patients undergoing PCI.
Authors:
Sunil V Rao; David Dai; Sumeet Subherwal; William S Weintraub; Ralph S Brindis; John C Messenger; Renato D Lopes; Eric D Peterson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-21     Completed Date:  2013-02-12     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  958-65     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Antithrombins / adverse effects
Centers for Medicare and Medicaid Services (U.S.)
Chi-Square Distribution
Comorbidity
Female
Hemorrhage / etiology*,  mortality
Hirudins / adverse effects
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Patient Readmission
Peptide Fragments / adverse effects
Percutaneous Coronary Intervention / adverse effects*,  mortality
Proportional Hazards Models
Recombinant Proteins / adverse effects
Registries
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
L30 HL104671/HL/NHLBI NIH HHS; T32 HL069749/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin
Comments/Corrections
Erratum In:
JACC Cardiovasc Interv. 2012 Nov;5(11):1192

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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