Clinical OriginalMajor bleeding complicating contemporary primary percutaneous coronary interventions—incidence, predictors, and prognostic implications
Introduction
Primary percutaneous coronary intervention (PCI) is a robust therapeutic approach for patients presenting with ST-elevation myocardial infarction (STEMI). The incidence of major bleeding among patients undergoing PCI varies between 2.2% and 17.6% [1], [2], [3], [4], [5], [6], [7]. Systemic bleeding may be affected by patients' characteristics and/or adjunctive antiplatelet and anticoagulation treatment used during the course of STEMI-related PCI [2], [8], [9]. Among those patients, baseline anemia was found to be a major predictor for adverse clinical outcomes [9]. The effect of peri-procedural bleeding on short- and intermediate-term prognosis in patients undergoing primary PCI was not fully elucidated. Accordingly, the current study aimed at evaluating the incidence, predictors, and prognostic impact of peri-procedural bleeding and blood transfusion in unselected “real-world” patient population who underwent primary PCI for STEMI using contemporary interventional approach.
Section snippets
Study population
We studied 831 consecutive patients who underwent primary PCI for STEMI between 1/2001 and 6/2005 at the Rabin Medical Center. Data was prospectively collected and entered into a uniform computerized registry format. All patients had to have baseline and post-procedure hemoglobin (Hb) levels. Patients who underwent emergent coronary artery bypass grafting surgery were excluded from the analysis.
Study definitions and follow-up data
Acute STEMI was defined as the presence for at least 30 min but less than 12 h of symptoms attributed
Baseline demographics
Major bleeding was observed in 27 (3.5%) of 831 acute STEMI patients who underwent primary PCI within 12 h of onset of chest pains. Patient demographics are described in Table 1. Patients who experienced major bleeding were older and 48% of them were above the age of 75 years. The proportion of women experiencing major bleeding (13/230, 5.7%) was 2.5 times higher than the proportion of men (14/601, 2.3%).
Angiographic and procedural results
Patients with major bleeding had similar procedural results and complications (Table 2).
Discussion
The current study main findings are as follows: (1) primary PCI for STEMI using contemporary intervention and adjunctive pharmacology is associated with relatively low rate of major bleeding; (2) major bleeding is associated with increased mortality rates; and (3) women are at increased risk for both major bleeding and blood transfusion.
In the current study, we observed a relatively low rate of major bleeding (3.5%). In comparison, the rate of peri-procedure major bleeding in a large cohort of
References (22)
- et al.
Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial
J Am Coll Cardiol
(2007) - et al.
Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials
Lancet
(2006) - et al.
Incidence, predictors and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions
Am J Cardiol
(2003) - et al.
Relationship between activated clotting time during percutaneous intervention and subsequent bleeding complications
Am Heart J
(2002) - et al.
Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score
J Am Coll Cardiol
(2005) - et al.
Thrombolysis in myocardial infarction (TIMI) trial—Phase 1: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase
J Am Coll Cardiol
(1988) - et al.
Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction
Am J Cardiol
(2005) - et al.
A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes
J Am Coll Cardiol
(2006) - et al.
Association of thrombocytopenia with the use of intra-aortic balloon pumps
Am J Med
(1998) - et al.
Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention
Am J Cardiol
(2006)
Beneficial effects of abciximab in patients with primary percutaneous intervention for acute ST segment elevation myocardial infarction in clinical practice
Heart
Cited by (52)
Gender Differences in Clinical Outcomes After Percutaneous Coronary Intervention—Analysis of 15,106 Patients from the Cardiac Registry of Pakistan Database
2023, American Journal of CardiologyCitation Excerpt :The differences in the use of anticoagulants or antiplatelets, platelet biology, congestive heart failure, and hypotension might explain this disparity;4,21 however, these factors were not explored in our study. Various studies have suggested a 3- to 10-fold increase in early mortality because of post-PCI bleeding, which might also explain the higher unadjusted mortality in women in our study.21,22 The difference in bleeding complication was not found in the younger subsample in both risk the unadjusted and adjusted analyses.
Racial and Gender Disparity in Aortoiliac Disease Open Revascularization Procedures
2020, Journal of Surgical ResearchRisk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs
2018, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Several studies have reported that antiplatelet treatment may increase the risk of bleeding after dental extraction and have reported the incidence of bleeding after extraction to be 17.4%.1–4 Other published studies have indicated that ageing is associated with a potentially increased risk of bleeding.5–7 Because antiplatelet drugs are widely used in the treatment of cardiovascular and cerebrovascular diseases (which are common among patients over the age of 60) the risk of bleeding after extraction must be assessed carefully before the procedure.
Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?
2016, Revista Portuguesa de CardiologiaTransradial primary percutaneous coronary intervention
2015, Interventional Cardiology Clinics