Prognostic implications of vascular complications following PCI.
OBJECTIVE
To evaluate the effect of vascular complications (VC) on the adjusted risk of nonfatal myocardial infarction (MI) or death following percutaneous coronary intervention (PCI) at 1 year in a large contemporary cohort.


BACKGROUND
Peri-procedural bleeding increases the risk of adverse clinical outcomes at 1 year. Whether access site VC's identify patients at high risk or independently alter the risk of adverse clinical outcomes at 1 year, however, is uncertain.


METHODS
3,931 PCI procedures performed via a femoral access at a single site (WFUBMC) were evaluated. Access and nonaccess site post procedural bleeding were assessed. The adjusted risk of access site VC's association with 1-year clinical outcomes was evaluated by Cox proportional hazards modeling.


RESULTS
Any VC occurred in 1.7%, and any TIMI bleeding in 6.7% after PCI. The hazard ratio (HR) adjusted for baseline and procedural covariates for any VC of nonfatal MI or all cause death at 1 year was 1.68 (1.00-2.81), P = 0.049 and 1.69 (0.92-3.09), P = 0.088 for all cause death alone. However, after adjusting for any TIMI bleeding, the HR for nonfatal MI or death was 0.84 (0.49-1.45), P = 0.527, and for death alone 0.75 (0.39-1.41), P = 0.369.


CONCLUSIONS
The occurrence of VC following PCI was an independent predictor of nonfatal MI or death at 1 year, but only if accompanied by TIMI major or minor bleeding. A vascular complication without TIMI bleeding did not alter prognosis at 1 year.
Applegate
Robert
R
Wake Forest School of Medicine, Section of Cardiology, Medical Center Boulevard, Winston-Salem, North Carolina, USA. bapplega@wfubmc.edu
Sacrinty
Matthew
M
Little
William
W
Gandhi
Sanjay
S
Kutcher
Michael
M
Santos
Renato
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011677:Punctures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology* / Q000401:mortality