Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: A report from the national cardiovascular data CathPCI registry

Sumeet Subherwal, Eric D. Peterson, David Dai, Laine Thomas, John C. Messenger, Ying Xian, Ralph G. Brindis, Dmitriy N. Feldman, Shaun Senter, Lloyd W. Klein, Steven P. Marso, Matthew T. Roe, Sunil V. Rao

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Abstract

Objectives: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Background: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. Methods: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. Results: An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001). Conclusions: The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.

Original languageEnglish (US)
Pages (from-to)1861-1869
Number of pages9
JournalJournal of the American College of Cardiology
Volume59
Issue number21
DOIs
StatePublished - May 22 2012

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Percutaneous Coronary Intervention
Registries
Hemorrhage
Unstable Angina
Odds Ratio
Blood Vessels
Logistic Models
Equipment and Supplies
Platelet Glycoprotein GPIIb-IIIa Complex
Bleeding Time
Thigh
Anticoagulants
Heparin
Non-ST Elevated Myocardial Infarction
ST Elevation Myocardial Infarction

Keywords

  • bleeding
  • catheterization
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention : A report from the national cardiovascular data CathPCI registry. / Subherwal, Sumeet; Peterson, Eric D.; Dai, David; Thomas, Laine; Messenger, John C.; Xian, Ying; Brindis, Ralph G.; Feldman, Dmitriy N.; Senter, Shaun; Klein, Lloyd W.; Marso, Steven P.; Roe, Matthew T.; Rao, Sunil V.

In: Journal of the American College of Cardiology, Vol. 59, No. 21, 22.05.2012, p. 1861-1869.

Research output: Contribution to journalArticle

Subherwal, Sumeet ; Peterson, Eric D. ; Dai, David ; Thomas, Laine ; Messenger, John C. ; Xian, Ying ; Brindis, Ralph G. ; Feldman, Dmitriy N. ; Senter, Shaun ; Klein, Lloyd W. ; Marso, Steven P. ; Roe, Matthew T. ; Rao, Sunil V. / Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention : A report from the national cardiovascular data CathPCI registry. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 21. pp. 1861-1869.
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abstract = "Objectives: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Background: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. Methods: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. Results: An approximate 20{\%} reduction in post-PCI bleeding was seen (elective PCI: 1.4{\%} to 1.1{\%}; UA/NSTEMI: 2.3{\%} to 1.8; STEMI: 4.9{\%} to 4.5{\%}). Radial approach remained low (<3{\%}), and closure device use increased marginally from 44{\%} to 49{\%}. Bivalirudin use increased (17{\%} to 30{\%}), whereas any heparin + GPI decreased (41{\%} to 28{\%}). There was a significant 6{\%} to 8{\%} per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5{\%} to 4{\%} for elective PCI, and 5.7{\%} to 2.8{\%} for UA/NSTEMI (both p <0.001). Conclusions: The nearly 20{\%} reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.",
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T2 - A report from the national cardiovascular data CathPCI registry

AU - Subherwal, Sumeet

AU - Peterson, Eric D.

AU - Dai, David

AU - Thomas, Laine

AU - Messenger, John C.

AU - Xian, Ying

AU - Brindis, Ralph G.

AU - Feldman, Dmitriy N.

AU - Senter, Shaun

AU - Klein, Lloyd W.

AU - Marso, Steven P.

AU - Roe, Matthew T.

AU - Rao, Sunil V.

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N2 - Objectives: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Background: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. Methods: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. Results: An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001). Conclusions: The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.

AB - Objectives: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Background: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. Methods: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. Results: An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001). Conclusions: The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.

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