Association Between Periprocedural Bleeding and Long-Term Outcomes Following Percutaneous Coronary Intervention in Older Patients
| Autor: | William S. Weintraub, Sumeet Subherwal, Sunil V. Rao, Ralph S. Brindis, Eric D. Peterson, Renato D. Lopes, David Dai, John C. Messenger |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Hemorrhage Comorbidity Kaplan-Meier Estimate elderly patients Patient Readmission Risk Assessment Antithrombins Centers for Medicare and Medicaid Services U.S Article Sex Factors Risk Factors medicine Humans Bivalirudin Hospital Mortality Registries cardiovascular diseases Aged Proportional Hazards Models Aged 80 and over Chi-Square Distribution business.industry Proportional hazards model percutaneous coronary intervention Hazard ratio Age Factors Percutaneous coronary intervention Hirudins medicine.disease Peptide Fragments Recombinant Proteins United States periprocedural bleeding Surgery Treatment Outcome Conventional PCI Female Cardiology and Cardiovascular Medicine business Chi-squared distribution Mace medicine.drug |
| Zdroj: | JACC: Cardiovascular Interventions. 5:958-965 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2012.05.010 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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