title: Association between periprocedural bleeding and long-term outcomes following percutaneous coronary intervention in older patients.
abstract: OBJECTIVE
  The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events (MACE), and mortality among older patients undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Bleeding complications after PCI are associated with an increased risk for acute morbidity and long-term mortality, but the association of these bleeding complications with other events is unknown.
  
  
  METHODS
  Patients entered into the National Cardiovascular Data Registry (NCDR) CathPCI Registry (n = 461,311; 946 sites) from January 2004 to December 2008 were linked with claims from the Centers for Medicare & Medicaid Services and grouped according to in-hospital post-PCI bleeding. The association between post-PCI bleeding and 1-, 12-, and 30-month readmission for bleeding, MACE, and all-cause mortality was examined with Cox regression that included patient and procedural characteristics using no bleeding as the reference.
  
  
  RESULTS
  Overall, 3.1% (n = 14,107) of patients experienced post-PCI bleeding. Patients who bled were older, more often female, had more medical comorbidities, less often received bivalirudin, and more often underwent PCI via the femoral approach. After adjustment, bleeding after the index procedure was significantly associated with readmission for bleeding (adjusted hazard ratios [95% confidence interval]: 1 month, 1.54 [1.42 to 1.67]; 12 months, 1.52 [1.40 to 1.66]; 30 months, 1.29 [1.11 to 1.50]), MACE (1 month, 1.11 [1.07 to 1.15]; 12 months, 1.17 [1.13 to 1.21]; 30 months, 1.12 [1.06 to 1.19]) and all-cause mortality (1 month, 1.32 [1.26 to 1.38]; 12 months, 1.33 [1.27 to 1.40]); 30 months, 1.22 [1.15 to 1.30]).
  
  
  CONCLUSIONS
  Post-PCI bleeding complications are associated with an increased risk for short- and long-term recurrent bleeding, MACE, and all-cause mortality. These data underscore the prognostic importance of periprocedural bleeding and the need for identifying strategies to reduce long-term bleeding risk among patients undergoing PCI.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina 27705, USA. sunil.rao@duke.edu
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Brindis
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects; D014487:Centers for Medicare and Medicaid Services, U.S.; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006629:Hirudins / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission; D010446:Peptide Fragments / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000009:adverse effects; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin