title: Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: a report from the National Cardiovascular Data CathPCI Registry.
abstract: OBJECTIVE
  The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown.
  
  
  METHODS
  Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio.
  
  
  RESULTS
  An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001).
  
  
  CONCLUSIONS
  The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27705, USA. sumeet.subherwal@duke.edu
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Brindis
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.forename: Shaun
authors.initials: S
authors.lastname: Senter
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012042:Registries; D013997:Time Factors