An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: A report using an expanded bleeding definition from the national cardiovascular data registry CathPCI registry

Sunil V. Rao, Lisa A. McCoy, John A. Spertus, Ronald J. Krone, Mandeep Singh, Susan Fitzgerald, Eric D. Peterson

Research output: Contribution to journalReview articlepeer-review

Abstract

Objectives This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. Background New knowledge about the importance of periprocedural bleeding combined with techniques to mitigate its occurrence and the inclusion of new data in the updated CathPCI Registry data collection forms encouraged us to develop a new bleeding definition and risk model to improve the monitoring and safety of PCI. Methods Detailed clinical data from 1,043,759 PCI procedures at 1,142 centers from February 2008 through April 2011 participating in the CathPCI Registry were used to identify factors associated with major bleeding complications occurring within 72 h post-PCI. Risk models (full and simplified risk scores) were developed in 80% of the cohort and validated in the remaining 20%. Model discrimination and calibration were assessed in the overall population and among the following pre-specified patient subgroups: females, those older than 70 years of age, those with diabetes mellitus, those with ST-segment elevation myocardial infarction, and those who did not undergo in-hospital coronary artery bypass grafting. Results Using the updated definition, the rate of bleeding was 5.8%. The full model included 31 variables, and the risk score had 10. The full model had similar discriminatory value across pre-specified subgroups and was well calibrated across the PCI risk spectrum. Conclusions The updated bleeding definition identifies important post-PCI bleeding events. Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.

Original languageEnglish (US)
Pages (from-to)897-904
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume6
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

Keywords

  • bleeding complications
  • bleeding risk models
  • percutaneous coronary intervention
  • quality improvement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: A report using an expanded bleeding definition from the national cardiovascular data registry CathPCI registry'. Together they form a unique fingerprint.

Cite this