Objectives The influence of the bleeding site on long-term survival after the primary percutaneous coronary intervention (PCI) is poorly understood. This study sought to investigate the relationship between in-hospital access site versus non-access site bleeding and very late mortality in unselected patients treated with primary PCI.
Methods Data of the 2715 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI, enrolled in a prospective registry of a high volume tertiary centre, were analysed. Bleeding events were assessed according to the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 4-year mortality.
Results The BARC type ≥2 bleeding occurred in 171 patients (6.3%). Access site bleeding occurred in 3.8%, and non-access site bleeding in 2.5% of patients. Four-year mortality was significantly higher for patients with bleeding (BARC type ≥2) than in patients without bleeding (BARC type 0+1), (36.3% vs 16.2%, p<0.001). Patients with non-access site bleeding had higher 4 year mortality (50.7% vs 26.5%, p=0.001). After multivariable adjustment, BARC type ≥2 bleeding was the independent predictor of 4 year mortality (HR 2.01; 95% CI 1.49 to 2.71, p<0.001). Patients with a non-access site bleeding were at 2-fold higher risk of very late mortality than patients with an access site bleeding (HR 2.62; 1.78 to 3.86, p<0.001 vs HR 1.57; 1.03 to 2.38, p=0.034).
Conclusions Both access and non-access site BARC type ≥2 bleeding is independently associated with a high risk of 4-year mortality after primary PCI. Patients with non-access site bleeding were at higher risk of late mortality than patients with access site bleeding.
- percutaneous coronary intervention
- acute myocardial infarction
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Contributors All authors have read and approved the manuscript. GRS: acts as guarantor; study conception and design; interpretation of data; drafting and revising the article and had final approval of the manuscript. DMM: study conception and design; acquisition, analysis and interpretation of data; drafted the article and had final approval of the manuscript. MRA, VDV and ZHM: study design, model construction and interpretation of results; drafted the article and had final approval of the manuscript. MMM, IBM, NMA, ADM, MNZ and GVK: study design and interpretation of data; revising the article and had final approval of the manuscript. JMM and NIK: acquisition and analysis of data; revising the article and had final approval of the manuscript. SDS, DGM and RML: study design and interpretation of data; revising the article and had final approval of the manuscript. GRS: study conception and design; interpretation of data; drafting and revising the article and had final approval of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval Ethics Committee of the Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Provenance and peer review Not commissioned; externally peer reviewed.
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