title: Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions.
abstract: Bleeding related to percutaneous coronary intervention (PCI) occurs relatively frequently. We retrospectively investigated the incidence, predictors, and prognostic impact of periprocedural bleeding and transfusion in 10,974 patients who underwent PCI. Bleeding definitions were based on Thrombolysis In Myocardial Infarction (TIMI) criteria: (1) major bleeding (n = 588; 5.4%): if patients had a hemorrhagic stroke or if hematocrit decreased >15 points or by 10 to 15 points with clinical bleeding; (2) minor bleeding (n = 1,394; 12.7%): if hematocrit decreased <10 points with clinical bleeding or by 10 to 15 points without clinical bleeding; and (3) no bleeding (n = 8,992; 81.9%): if hematocrit decreased <10 points without clinical bleeding. Patients with major bleeding were older than patients with minor or no bleeding (67.8 +/- 11 vs 65.9 +/- 11 vs 63.6 +/- 11 years, respectively; p <0.001) and more often experienced intraprocedural complications, such as emergency use of an intra-aortic balloon pump (13.6% vs 6.5% vs 2.3%, respectively; p <0.001). Multivariate logistic regression analysis identified the use of an intra-aortic balloon pump (odds ratio [OR] 3.0, p <0.0001), procedural hypotension (OR 2.9, p <0.001), and age >80 years (OR 1.9 compared with age <50 years, p = 0.001) as the strongest predictors for major bleeding. Patients who had major bleeding had higher in-hospital and 1-year mortality compared with patients with minor or no bleeding. Bleeding was an independent predictor of in-hospital death. Thus, periprocedural major bleeding occurs relatively frequently and is associated with adverse outcomes. Patients >80 years of age who experience intraprocedural complications are at particularly high risk.
authors.affiliation: Cardiovascular Research Institute and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, DC 20010, USA. tim.kinnaird@medstar.net
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Kinnaird
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Canos
authors.forename: Natalie
authors.initials: N
authors.lastname: Gevorkian
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Pinnow
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000150:complications; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007431:Intraoperative Complications; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000150:complications