title: Major bleeding complicating contemporary primary percutaneous coronary interventions-incidence, predictors, and prognostic implications.
abstract: BACKGROUND
  Major bleeding is one of the most frequent procedural-related complications of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infraction (STEMI). We investigated the incidence, predictors, and prognostic impact of peri-procedural bleeding in a cohort of unselected patients undergoing contemporary primary PCI.
  
  
  METHODS
  A total of 831 consecutive patients who underwent primary PCI between 1/2001 and 6/2005 were studied. Major bleeding was defined as hemorrhagic stroke, hemoglobin (Hb) drop of >5 g%, or 3-5 g% with a need for blood transfusion. Clinical outcomes were evaluated at 30 days and 6 months.
  
  
  RESULTS
  Major bleeding occurred in 27 patients (3.5%). Those who experienced major bleeding were older (66+/-15 vs. 61+/-13, P=.02), more frequently female gender (48% vs. 27%, P=.0001), presented more often with cardiogenic shock (37% vs. 8%, P=.0001), and had higher CADILLAC score (7.8+/-4.5 vs. 5.1+/-4.0, P=.002) and activated clotting time (ACT) levels (284+/-63 vs. 248+/-57 s, P=.007). In multivariate analysis, significant predictors of major bleeding were female gender (OR 5.1, 95% CI 1.7-15.2, P=.004), ACT levels >250 s (OR 3.6, 95% CI 1.1-12.1, P=.04), and use of intra-aortic balloon pump (IABP) (OR 3.5, 95% CI 1.0-12.1, P=.047). Major bleeding was associated with increased 6-month mortality rates (37% vs. 10%, P=.0001), which remained significant after adjustment for baseline CADILLAC score (37% vs. 19.4%, P=.05).
  
  
  CONCLUSIONS
  Major bleeding complicating primary PCI is associated with increased 6-month mortality. Women and those who need IABP support are at particularly high risk. Tight monitoring of anticoagulation may reduce the risk of bleeding.
authors.affiliation: Cardiology Department, Rabin Medical Center, Golda-Hasharon Campus, Petach Tikva, Israel. shmuelf@clalit.org.il
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Abed
authors.initials: A
authors.lastname: Assali