title: Incidence, Predictors and Outcomes of Major Bleeding in Patients Following Percutaneous Coronary Interventions in Australia.
abstract: BACKGROUND
  Major bleeding is a serious complication of percutaneous coronary intervention (PCI). We set out to investigate the incidence of major bleeding and its impact on hospitalisation and long-term mortality.
  
  
  METHODS
  We examined seven years of registry data encompassing 16,860 PCI procedures.
  
  
  RESULTS
  Between 2005 and 2011 major bleeding increased from 1.3% to 3.4%. In patients with ST elevated myocardial infarction (STEMI), the rate increased from 2.3% to 6.4%. The increase remained significant after adjusting for patient and procedural characteristics (OR=1.09/year, p=0.001). Bleeding risk was highest in patients presenting with out-of-hospital cardiac arrest and cardiogenic shock (CS). Women, STEMI patients, those aged over 70yrs or weighing <60kg were at higher risk. Glycoprotein IIb/IIIa-inhibitor use more than doubled the risk of bleeding (OR=2.28, p=<0.001). Mortality rates at one year were 4.18% overall and 7.9% in STEMI. Bleeding was a strong predictor of mortality after adjusting for potential confounders (HR=2.92, 95% CI: 2.08, 4.09). Bleeding significantly increased length of stay (med four days vs seven days) and rehospitalisation at 12 months (OR=1.36, 95% CI: 1.08, 1.70).
  
  
  CONCLUSIONS
  Major bleeding rates post-PCI appear to be increasing in Australia. Bleeding increases hospitalisation and is associated with poor clinical outcomes.
authors: John Wlodarczyk Consulting Services, Newcastle, NSW, Australia.
authors: John
authors: J
authors: Wlodarczyk
authors: Monash University, Melbourne, Vic, Australia and Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: Andrew.Ajani@mh.org.au.
authors: Andrew E
authors: AE
authors: Ajani
authors: John Wlodarczyk Consulting Services, Newcastle, NSW, Australia.
authors: Dante
authors: D
authors: Kemp
authors: Monash University, Melbourne, Vic, Australia and Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Vic, Australia.
authors: Nick
authors: N
authors: Andrianopoulos
authors: Monash University, Melbourne, Vic, Australia and Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Vic, Australia.
authors: Angela L
authors: AL
authors: Brennan
authors: Alfred Hospital, Melbourne, Vic, Australia.
authors: Stephen J
authors: SJ
authors: Duffy
authors: Austin Hospital, Melbourne, Vic, Australia.
authors: David J
authors: DJ
authors: Clark
authors: Monash University, Melbourne, Vic, Australia and Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Vic, Australia.
authors: Christopher M
authors: CM
authors: Reid
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
keywords: Bleeding; Hospitalisation; Mortality; PCI; Percutaneous coronary intervention; STEMI