Article Text

Download PDFPDF
Original research article
Impact on long-term mortality of access and non-access site bleeding after primary percutaneous coronary intervention
  1. Dragan M Matic1,
  2. Milika R Asanin1,
  3. Vladan D Vukcevic2,
  4. Zlatko H Mehmedbegovic2,
  5. Jelena M Marinkovic3,
  6. Nikola I Kocev3,
  7. Marija M Marjanovic2,
  8. Igor B Mrdovic1,
  9. Nebojsa M Antonijevic1,
  10. Aleksandra D Milosevic1,
  11. Milorad N Zivkovic2,
  12. Gordana V Krljanac1,
  13. Sanja Dj Stankovic4,
  14. Dejan G Milasinovic2,
  15. Ratko M Lasica1,
  16. Goran R Stankovic2
  1. 1 Emergency Department, Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  2. 2 Department for Diagnostic and Catheterization Laboratories, Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  3. 3 Institute for Medical Statistics and Health Research, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  4. 4 Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
  1. Correspondence to Dr Goran R Stankovic, Department for Diagnostic and Catheterization Laboratories, Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia ; gorastan{at}sbb.rs

Abstract

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
View Full Text

Statistics from Altmetric.com

Footnotes

  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.