title: Comparison of Bleeding Outcomes After Percutaneous Coronary Intervention in Patients With Versus Without Aortic Stenosis.
abstract: Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS.
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Huffman
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Omid
authors.initials: O
authors.lastname: Fatemi
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Gai
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: William
authors.initials: W
authors.lastname: Suddath
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Lowell
authors.initials: L
authors.lastname: Satler
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pichard
authors.affiliation: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors