title: Prognostic value of access and non-access sites bleeding after percutaneous coronary intervention.
abstract: BACKGROUND
  Little is known about the impact of bleeding site on mortality after percutaneous coronary intervention. The aim of this study was to assess the impact of access and non-access site bleeding within 30 days after percutaneous coronary intervention on mortality.
  
  
  RESULTS
  This study represents a pooled patient-level analysis of 14 180 patients recruited in 7 randomized trials. Access and non-access site bleeding were assessed using the Bleeding Academic Research Consortium criteria. The primary outcome was 1-year mortality. Follow-up was complete in 97.5% of the patients. There were 414 deaths within the first year after percutaneous coronary intervention: 44 deaths among patients with access site bleeding, 60 deaths among patients with non-access site bleeding, and 310 deaths among patients without bleeding (Kaplan-Meier estimates of mortality, 4.5%, 10.0%, and 2.5%, respectively; adjusted hazard ratio, 1.72 [95% confidence interval, 1.19-2.47] for access site bleeding versus no bleeding; hazard ratio, 2.78 [2.00-3.86] for non-access site versus no bleeding). The inclusion of non-access site bleeding (the absolute and relative integrated discrimination improvement, 0.005 and 8.9%; P=0.031) but not of access site bleeding (the absolute and relative integrated discrimination improvement, 0.0015 and 2.7%; P=0.084) was associated with an improvement of the discriminatory power of multivariable model for mortality prediction.
  
  
  CONCLUSIONS
  Both access and non-access site bleeding events occurring within 30 days of a percutaneous coronary intervention are independently associated with an increased risk of 1-year mortality. Non-access site bleeding is a stronger correlate of mortality than access site bleeding, and it improves the discriminatory power of models for mortality prediction.
authors.affiliation: Deutsches Herzzentrum München, Technische Universität, München, Germany.
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.forename: Ralph
authors.initials: R
authors.lastname: Tölg
authors.forename: Kiril M
authors.initials: KM
authors.lastname: Stoyanov
authors.forename: Michael
authors.initials: M
authors.lastname: Gick
authors.forename: Tareq
authors.initials: T
authors.lastname: Ibrahim
authors.forename: Katrin Anette
authors.initials: KA
authors.lastname: Fiedler
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Laugwitz
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models
keywords: hemorrhage; mortality; percutaneous coronary intervention