title: Impact of major bleeding on long-term mortality in anemic versus nonanemic patients undergoing percutaneous coronary intervention using bivalirudin.
abstract: Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York; Center for Interventional Vascular Therapy, Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: zaa2112@columbia.edu.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Shyam
authors.initials: S
authors.lastname: Poludasu
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York.
authors.forename: Yasir H
authors.initials: YH
authors.lastname: Qureshi
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York.
authors.forename: Ayyaz A
authors.initials: AA
authors.lastname: Ali
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York; Department of Biomedical Informatics, Columbia University, New York, New York.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tatonetti
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Downey
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Adrian
authors.initials: A
authors.lastname: Zalewski
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York.
authors.forename: Tamim
authors.initials: T
authors.lastname: Nazif
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University, New York, New York.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Anupa
authors.initials: A
authors.lastname: Mandava
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Division of Cardiology, Mount Sinai Hospital and School of Medicine, New York, New York.
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000747:Anemia, Hypochromic / Q000150:complications*; D000991:Antithrombins / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin