title: Complications related to access site after percutaneous coronary interventions: are the adverse events underreported?
abstract: OBJECTIVE
  The primary objective was to compare the NCDR rate of four access site related complications (arteriovenous fistula, pseudoaneurysm, retroperitoneal bleed, and blood transfusion) with that obtained independently within a Quality Improvement (QI) Database. The secondary objective was to determine the in-hospital mortality related to these complications.
  
  
  BACKGROUND
  NCDR is the most comprehensive database of post-PCI patients and a method by which hospitals are compared for quality of care and outcomes. The collected data include in-hospital events only, therefore reporting for same day and/or early discharges may fail to capture adverse events. We hypothesized that the actual rate of complications post-PCI may be higher than the rate reported in NCDR.
  
  
  METHODS
  Adverse events following PCIs were collected in a QI database. We compared the rate of four above mentioned complications between NCDR and our QI database for the time period between January 1, 2005 and December 31, 2008.
  
  
  RESULTS
  A total of 3,940 PCIs were performed on 3,430 patients in the four-year interval. The incidence of the combined endpoint of the four adverse events was 4.1% (161 events) in NCDR, vs. 4.7% (186 events) in QI database, a 13% higher yield. There was significantly higher in-hospital mortality in the complication group with regards to both all cause (4.7% vs. 1.1%, P < 0.0001) and cardiovascular mortality (2.7% vs. 1%, P = 0.046).
  
  
  CONCLUSIONS
  Access site related complications occurred 13% more than what was reported in NCDR and were associated with a greater than fourfold increase in in-hospital mortality.
authors.affiliation: Geisinger Medical Center, Department of Cardiology, Danville, Pennsylvania, USA. vcrudu1@geisinger.edu
authors.forename: Vitalie
authors.initials: V
authors.lastname: Crudu
authors.forename: James
authors.initials: J
authors.lastname: Blankenship
authors.forename: Peter
authors.initials: P
authors.lastname: Berger
authors.forename: Thomas
authors.initials: T
authors.lastname: Scott
authors.forename: Kimberly
authors.initials: K
authors.lastname: Skelding
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000209:etiology* / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000401:mortality; D001803:Blood Transfusion / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D019992:Databases as Topic; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011677:Punctures; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors