Prognostic value of access site and nonaccess site bleeding after percutaneous coronary intervention: a cohort study in ST-segment elevation myocardial infarction and comprehensive meta-analysis.
OBJECTIVE
This study sought to investigate the prognostic value of access site bleeding (ASB) and non-ASB for recurrent ischemic outcomes and mortality in patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
The prognostic value of ASB-related complications after STEMI is subject to debate.


METHODS
The prognostic value of ASB and non-ASB for 1-year mortality, recurrent myocardial infarction (MI), stent thrombosis, and stroke was investigated in 2,002 STEMI patients undergoing primary percutaneous coronary intervention. In addition, we performed a meta-analysis of studies investigating the prognostic value of ASB and non-ASB in patients undergoing percutaneous coronary intervention.


RESULTS
Seventy-four patients (3.7%) were treated by radial access. ASB developed in 124 patients (6.3%) and non-ASB developed in 102 (5.2%). By multivariable analysis, ASB was not associated with a higher risk of 1-year mortality (hazard ratio [HR]: 1.03; p = 0.89), recurrent MI (HR: 1.16; p = 0.64), stent thrombosis (HR: 0.55; p = 0.42), or stroke (HR: 0.47; p = 0.31). Non-ASB was independently associated with 1-year mortality (HR: 2.77; p < 0.001) and stent thrombosis (HR: 3.10; p = 0.021), but not with recurrent MI and stroke. In a meta-analysis including 495,630 patients, non-ASB was associated with a greater adjusted risk of subsequent 1-year mortality than ASB (HR: 1.66; 95% CI: 1.56 to 1.76 and HR: 1.21; 95% CI: 1.11 to 1.31).


CONCLUSIONS
In STEMI, ASB was not significantly associated with 1-year clinical outcomes, whereas non-ASB was significantly associated with 1-year mortality and stent thrombosis. These results taken together with those of previous studies indicate a greater risk of subsequent mortality in patients with non-ASB.
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Wouter J
WJ
Kikkert
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Ronak
R
Delewi
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Dagmar M
DM
Ouweneel
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Sophie H
SH
van Nes
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Marije M
MM
Vis
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan
J
Baan
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Karel T
KT
Koch
Cardiovascular Research Foundation, New York, New York; Mount Sinai Medical Center, New York, New York.
George D
GD
Dangas
Cardiovascular Research Foundation, New York, New York; Mount Sinai Medical Center, New York, New York.
Roxana
R
Mehran
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Robbert J
RJ
de Winter
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Ron J G
RJ
Peters
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan J
JJ
Piek
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan G P
JG
Tijssen
Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.p.henriques@amc.uva.nl.
Jose P S
JP
Henriques
D014943:Global Health; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D015996:Survival Rate / Q000639:trends
ST-segment elevation myocardial infarction; major bleeding; percutaneous coronary intervention; primary percutaneous coronary intervention; vascular access site