title: Incidence of overall bleeding in patients treated with intra-aortic balloon pump during percutaneous coronary intervention: 12-year Milan experience.
abstract: OBJECTIVE
  This study aims to report a "real-world" experience of in hospital complications and clinical outcome of a large cohort of consecutive patients who underwent percutaneous coronary intervention (PCI) with intra-aortic balloon pump counterpulsation (IABP) support, from a tertiary care center over a 12-year period.
  
  
  BACKGROUND
  The incidence of vascular complications in patients treated with PCI and IABP is expected to be higher due to simultaneous puncture of femoral arteries, larger IABP sheath size, and longer duration of IABP therapy.
  
  
  METHODS
  A total of 360 consecutive patients (mean age of 65.9 ± 11.2 years; 80.6% male) who required an IABP support during percutaneous PCI were classified into 3 groups: Urgent: 133 patients (36.9%) admitted with acute coronary syndrome in whom IABP therapy was started before urgent PCI; Emergent: 56 patients (15.6%) in whom emergent IABP insertion was required to manage hypotension during PCI; and Elective: 171 patients (47.5%) with stable angina pectoris in whom IABP was inserted before elective PCI. Overall bleeding was defined according to the newest the Bleeding Academic Research Consortium (BARC) definition criteria.
  
  
  RESULTS
  BARC bleeding occurred in 68 patients (19%), with the highest incidence noted in the Urgent group (31.1%), in comparison with the Emergent (26.8%) and Elective (7%) groups, p < 0.0001. Bleeding related to the IABP access site was 7.5%, which accounted for 82% of any access site-related bleeding. It was significantly higher in the Urgent group (12.8%) compared with the Elective (4.1%) and Emergent (5.4%) groups. At multivariate analysis, IABP treatment duration and renal impairment were the only independent predictors of BARC bleeding.
  
  
  CONCLUSIONS
  Bleeding related to the IABP access site was significantly higher in the Urgent group and accounted for more than two-thirds of overall access site-related bleeding. IABP treatment duration and renal impairment were independent predictors of overall bleeding.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giedrius
authors.initials: G
authors.lastname: Davidavicius
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Joanne
authors.initials: J
authors.lastname: Shannon
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Letizia
authors.initials: L
authors.lastname: Bertoldi
authors.forename: Marco
authors.initials: M
authors.lastname: Mussardo
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Francesco
authors.initials: F
authors.lastname: Arioli
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Mateo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects* / Q000401:mortality; D007558:Italy; D007674:Kidney Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011677:Punctures / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome