title: Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis.
abstract: To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions.
  
  
  
  We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic.
  
  
  
  42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes.
  
  
  
  Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.
authors.affiliation: Cardiovascular Institute, University of Manchester , Manchester , UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Department of Cardiology , Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina , USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Division of Applied Health Sciences , School of Medicine & Dentistry, University of Aberdeen , Aberdeen , Scotland , UK.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Cardiovascular Institute, University of Manchester , Manchester , UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Keavney
authors.affiliation: Department of Cardiology , University Hospital North Staffordshire , Stoke-on-Trent , UK.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Department of Cardiology , Queen Elizabeth Hospital , Birmingham , UK.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: Cardiothoracic Division , The James Cook University Hospital , Middlesbrough , UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Norwich Medical School, University of East Anglia , Norwich , UK.
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: Cardiovascular Institute, University of Manchester , Manchester , UK.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
keywords: ALLIED SPECIALITIES; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)