title: Incidence and correlates of major bleeding after percutaneous coronary intervention across different clinical presentations.
abstract: BACKGROUND
  Bleeding after percutaneous coronary intervention (PCI) is identified as a strong predictor for adverse events, including mortality. This study aims to compare the incidence and correlates of post-PCI bleeding across different clinical presentations.
  
  
  METHODS
  The study included 23,943 consecutive PCI patients categorized according to their clinical presentation: stable angina pectoris (n = 6,741), unstable angina pectoris (UAP) (n = 5,215), non-ST-segment elevation myocardial infarction (NSTEMI) (n = 8,418), ST-segment elevation myocardial infarction (STEMI) (n = 2,721), and cardiogenic shock (CGS) (n = 848).
  
  
  RESULTS
  Severity of clinical presentation was associated with a greater use of preprocedural anticoagulation, glycoprotein IIb/IIIa inhibitors, and intraaortic balloon pump (IABP). TIMI-defined major bleeding increased with increasing severity of clinical presentation: stable angina pectoris, 0.7%; UAP, 1.0%; NSTEMI, 1.6%; STEMI, 4.6%; and CGS, 13.5% (P < .001). On multivariable analysis, CGS (odds ratio [OR], 4.67; 95% CI [2.62-8.34]), STEMI (OR, 3.39; 95% CI [2.07-5.55]), and NSTEMI (OR, 2.00; 95% CI [1.29-3.10]) remained correlated with major bleeding even after adjusting for baseline and procedural differences, whereas UAP did not. The multivariable model also identified the use of IABP, female gender, congestive heart failure, no prior PCI, increased baseline hematocrit, and increased procedure time as correlates for major bleeding.
  
  
  CONCLUSIONS
  In patients undergoing PCI, the worsening severity of clinical presentation corresponds to an increase in incidence of post-PCI major bleeding. The increased risk with CGS, STEMI, and NSTEMI persisted despite adjusting for more aggressive pharmacotherapy and use of IABP. Careful attention to antithrombotic pharmacotherapy is warranted in this high-risk population.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lakshmana K
authors.initials: LK
authors.lastname: Pendyala
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto A
authors.initials: AA
authors.lastname: Pichard
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@gmail.com.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000787:Angina Pectoris / Q000628:therapy; D000789:Angina, Unstable / Q000628:therapy; D015897:Comorbidity; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009203:Myocardial Infarction / Q000628:therapy; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index