Postdischarge Bleeding After Percutaneous Coronary Intervention and Subsequent Mortality and Myocardial Infarction: Insights From the HMO Research Network-Stent Registry.
Bleeding after hospital discharge from percutaneous coronary intervention (PCI) is associated with increased risk of subsequent myocardial infarction (MI) and death; however, the timing of adverse events after these bleeding events is poorly understood. Defining this relationship may help clinicians identify critical periods when patients are at highest risk.



All patients undergoing PCI from 2004 to 2007 who survived to hospital discharge without a bleeding event were identified from the HMO Research Network-Stent (HMORN-Stent) Registry. Postdischarge rates and timing of bleeding-related hospitalizations, MI, and death were defined. We then assessed the association between postdischarge bleeding-related hospitalizations with death and MI using Cox proportional hazards models. Among 8137 post-PCI patients surviving to hospital discharge without in-hospital bleeding, 391 (4.8%) had bleeding-related hospitalization after discharge, with the highest incidence of bleeding-related hospitalizations occurring within 30 days of discharge (n=79, 20.2%). Postdischarge bleeding-related hospitalization after PCI was associated with subsequent death or MI (hazard ratio, 3.09; 95% confidence interval, 2.41-3.96), with the highest risk for death or MI occurring in the first 60 days after bleeding-related hospitalization (hazard ratio, 7.16; confidence interval, 3.93-13.05).



Approximately 1 in 20 post-PCI patients are readmitted for bleeding, with the highest incidence occurring within 30 days of discharge. Patients having postdischarge bleeding are at increased risk for subsequent death or MI, with the highest risk occurring within the first 60 days after a bleeding-related hospitalization. These findings suggest a critical period after bleeding events when patients are most vulnerable for further adverse events.
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.). javier.valle@ucdenver.edu.
Javier A
JA
Valle
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
Susan
S
Shetterly
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
Thomas M
TM
Maddox
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
P Michael
PM
Ho
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
Steven M
SM
Bradley
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
Amneet
A
Sandhu
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
David
D
Magid
From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.).
Thomas T
TT
Tsai
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality*; D010351:Patient Discharge; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
hemorrhage; myocardial infarction; percutaneous coronary intervention; stent; survival