Weight of the bleeding impact on early and late mortality after percutaneous coronary intervention.
The association between bleeding and timing of mortality after percutaneous coronary intervention (PCI) remains poorly investigated. We aimed to investigate the impact of bleeding on early (30-day) and late (30-day to 1 year) mortality after PCI. The study includes 14,180 patients. Bleeding within 30 days after PCI was defined using the Bleeding Academic Research Consortium criteria. Landmark analysis pre-specified at 1 month was performed to assess early and late mortality associated with bleeding. The main outcome was all-cause early and late mortality after PCI. Overall, 414 patients (2.9 %) died within the first year after PCI. Within 30 days after PCI there were 36 deaths among patients with bleeding (n = 1,510) and 44 deaths among patients without bleeding (n = 12,670; Kaplan-Meier [KM] estimates of mortality, 2.4 and 0.3 %; adjusted hazard ratio [HR] = 5.00, 95 % confidence interval 3.16-7.88, P < 0.001). In the 30-day to 1-year period there were 68 deaths among patients with bleeding and 266 deaths among patients without bleeding (KM estimates, 4.7 and 2.1 %; adjusted HR = 1.65 [1.25-2.17], P < 0.001. Bleeding was the strongest correlate of 30-day mortality. The association of bleeding with late mortality was significant but was weaker than that of age, diabetes, C-reactive protein, serum creatinine and platelet count. In conclusion, patients with bleeding after PCI continue to be at higher risk of early and late mortality compared to patients without bleeding. Bleeding was the strongest associate of early mortality whereas the increased risk for late mortality was mostly mediated by cardiovascular risk factors clustered in patients with bleeding.
Deutsches Herzzentrum, Lazarettstrasse 36, 80636, Munich, Germany, ndrepepa@dhm.mhn.de.
Gjin
G
Ndrepepa
Elena
E
Guerra
Stefanie
S
Schulz
Massimiliano
M
Fusaro
Salvatore
S
Cassese
Adnan
A
Kastrati
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013997:Time Factors