title: Bleeding complications in primary percutaneous coronary intervention of ST-elevation myocardial infarction in a radial center.
abstract: OBJECTIVE
  We evaluated the incidence, types, and prognostic impact of bleeding complications in a non-selected patient population with ongoing STEMI treated with aggressive antithrombotic treatment and routine radial primary PCI.
  
  
  BACKGROUND
  Bleeding complications remain frequent and deleterious in primary PCI through femoral approach.
  
  
  METHODS
  STEMI patients (n = 671) were evaluated for bleeding complications using a web-based registry (e-PARIS). In-hospital bleeding was adjudicated using the TIMI definition.
  
  
  RESULTS
  In this non-selected, high risk population, 6.1% had cardiogenic shock on admission, 3.9% out-of-hospital cardiac arrest. Radial access (88%) was the default strategy as was abciximab (78%). Clopidogrel loading dose ranged from 300 to 900 mg. Pre-hospital fibrinolysis was rare (7.1%). Hemodynamic support devices (IABP, ECMO, Tandem Heart) were needed in 7.0%. In-hospital TIMI Major and TIMI Major/minor bleedings occurred in 2.5 and 5.7% of the population, respectively. In-hospital and 1-year mortality rates were 5.5 and 8.2%, respectively. Patients with in-hospital TIMI Major/minor bleeding had a higher 1-year mortality rate (31.6% vs. 3.8%, P < 0.001). The most frequent bleeding site was gastro-intestinal. Radial access was a strong predictor of survival (OR 0.33; 95%CI 0.17-0.56; P = 0.002).
  
  
  CONCLUSIONS
  In the setting of radial primary PCI, the rates and types of bleeding complications are somewhat different from those observed with femoral primary PCI. The gastro-intestinal tract has become the most frequent site of bleeding after radial primary PCI. The use of radial access appears independently associated with survival.
authors.affiliation: Institut de Cardiologie (APHP), INSERM U937 and Univ Paris 6, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.forename: Anne
authors.initials: A
authors.lastname: Mercadier
authors.forename: Remi
authors.initials: R
authors.lastname: Lancar
authors.forename: Anne
authors.initials: A
authors.lastname: Bellemain-Appaix
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000077284:Abciximab; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D015994:Incidence; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010297:Paris; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D016016:Proportional Hazards Models; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab