title: Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention.
abstract: BACKGROUND
  Transradial access (TRA) has been associated with reduced access site-related bleeding complications and mortality after percutaneous coronary intervention (PCI). It is unclear, however, whether these observed benefits are influenced by baseline bleeding risk.
  
  
  OBJECTIVE
  This study investigated the relationship between baseline bleeding risk, TRA utilization, and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database.
  
  
  METHODS
  Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in 348,689 PCI procedures performed between 2006 and 2011. Four categories for bleeding risk were defined for the modified Mehran risk score (MMRS): low (<10), moderate (10 to 14), high (15 to 19), and very high (≥20). The impact of baseline bleeding risk on 30-day mortality and its relationship with access site were studied.
  
  
  RESULTS
  TRA was independently associated with a 35% reduction in 30-day mortality risk (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.59 to 0.72]; p < 0.0001), with the magnitude of mortality reduction related to baseline bleeding risk (MMRS <10, OR: 0.73 [95% CI: 0.62 to 0.86]; MMRS ≥20, OR: 0.53 [95% CI: 0.47 to 0.61]). In patients with an MMRS <10, TRA was used in 71,771 (43.2%) of 166,083 PCI procedures; TRA was used in 8,655 (40.1%) of 21,559 PCI procedures in patients with an MMRS ≥20, illustrating that TRA was used less in those at highest risk from bleeding complications (p < 0.0001).
  
  
  CONCLUSIONS
  TRA was independently associated with reduced 30-day mortality, and the magnitude of this effect was related to baseline bleeding risk; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI.
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Farr Institute, University of Manchester, Manchester, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carr
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.affiliation: Farr Institute, University of Manchester, Manchester, United Kingdom; Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: The Heart Hospital, University College London Hospitals, London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fraser
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: Mehran risk score; access site; bleeding risk; femoral; outcomes; radial; transfemoral; transradial