title: Prognostic implications of vascular complications following PCI.
abstract: 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.
authors.affiliation: Wake Forest School of Medicine, Section of Cardiology, Medical Center Boulevard, Winston-Salem, North Carolina, USA. bapplega@wfubmc.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Applegate
authors.forename: Matthew
authors.initials: M
authors.lastname: Sacrinty
authors.forename: William
authors.initials: W
authors.lastname: Little
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
authors.forename: Michael
authors.initials: M
authors.lastname: Kutcher
authors.forename: Renato
authors.initials: R
authors.lastname: Santos
mesh_terms: 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