Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention
Background/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with STelevation myocard...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2015-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400064M.pdf |
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| author | Matić Dragan M. Ašanin Milika R. Stanković Sanja Đ. Mrdović Igor B. Marinković Jelena M. Kočev Nikola I. Antonijević Nebojša M. Marjanović Marija M. Nešić Zorica I. Prostran Milica S. Stanković Goran R. |
| author_facet | Matić Dragan M. Ašanin Milika R. Stanković Sanja Đ. Mrdović Igor B. Marinković Jelena M. Kočev Nikola I. Antonijević Nebojša M. Marjanović Marija M. Nešić Zorica I. Prostran Milica S. Stanković Goran R. |
| author_sort | Matić Dragan M. |
| collection | DOAJ |
| description | Background/Aim. Data about bleeding complicating primary percutaneous
coronary intervention (PCI) are more frequently obtained from randomized
clinical trials on patients with acute coronary syndromes (ACS), but less
frequently from surveys or registries on patients with STelevation myocardial
infarction (STEMI). The aim of this study was to investigate the incidence,
predictors and prognostic impact of in-hospital major bleeding in the
population of unselected real-world patients with acute STEMI undergoing
primary PCI. Methods. All consecutive patients presenting with STEMI who
underwent primary PCI at a single large tertiary healthcare center between
January 2005 and July 2009, were studied. Major bleeding was defined
according to the Global Use of Strategies to Open Occluded Coronary Arteries
(GUSTO) study criteria. We examined the association between in-hospital major
bleeding and death or major adverse cardiac events (MACE) in patients treated
with PCI. The primary outcomes were in-hospital and 6-month mortality and
MACE. Results. Of the 770 STEMI patients treated with primary PCI,
in-hospital major bleeding occurred in 32 (4.2%) patients. Independent
predictors of major bleeding were advanced age (≥ 65 years), female gender,
baseline anemia and elevated white blood cell (WBC) count and signs of
congestive heart failure at admission (Killip class II-IV). In-hospital and
6-month mortality and MACE rates were more than 2.5-fold-higher in patients
who developed major bleeding compared with those who did not. Major bleeding
was a predictor of 6- month MACE, independent of a few risk factors (previous
MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for
OR 1.20-7.61; p = 0.019), but was not a true independent predictor of MACE
and mortality in the fully adjusted models. Conclusion: Patients of advanced
age, female gender, with baseline anemia and elevated WBC count and those
with Killip class II-IV at presentation are at particularly high risk of
bleeding after primary PCI. Bleeding is associated with adverse outcome and
may be an important marker of patient frailty, but it is not a true
independent predictor of mortality/MACE. |
| format | Article |
| id | doaj-art-7cd90d9318f74a57ac3f5f64ac55eae5 |
| institution | Kabale University |
| issn | 0042-8450 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-7cd90d9318f74a57ac3f5f64ac55eae52025-08-20T03:35:28ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502015-01-0172758959510.2298/VSP140223064M0042-84501400064MIncidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary interventionMatić Dragan M.0Ašanin Milika R.1Stanković Sanja Đ.2Mrdović Igor B.3Marinković Jelena M.4Kočev Nikola I.5Antonijević Nebojša M.6Marjanović Marija M.7Nešić Zorica I.8Prostran Milica S.9Stanković Goran R.10Clinical Center of Serbia, Clinic for Cardiology, BelgradeClinical Center of Serbia, Clinic for Cardiology, Belgrade + Faculty of Medicine, BelgradeClinical Center of Serbia, Center for Medical Biochemistry, BelgradeClinical Center of Serbia, Clinic for Cardiology, Belgrade + Faculty of Medicine, BelgradeFaculty of Medicine, Institute for Medical Statistics and Health Research, BelgradeFaculty of Medicine, Institute for Medical Statistics and Health Research, BelgradeClinical Center of Serbia, Clinic for Cardiology, Belgrade + Faculty of Medicine, BelgradeClinical Center of Serbia, Clinic for Cardiology, BelgradeFaculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, BelgradeFaculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, BelgradeClinical Center of Serbia, Clinic for Cardiology, Belgrade + Faculty of Medicine, BelgradeBackground/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with STelevation myocardial infarction (STEMI). The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI. Methods. All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE) in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE. Results. Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2%) patients. Independent predictors of major bleeding were advanced age (≥ 65 years), female gender, baseline anemia and elevated white blood cell (WBC) count and signs of congestive heart failure at admission (Killip class II-IV). In-hospital and 6-month mortality and MACE rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was a predictor of 6- month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for OR 1.20-7.61; p = 0.019), but was not a true independent predictor of MACE and mortality in the fully adjusted models. Conclusion: Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at particularly high risk of bleeding after primary PCI. Bleeding is associated with adverse outcome and may be an important marker of patient frailty, but it is not a true independent predictor of mortality/MACE.http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400064M.pdfangioplasty, transluminal, percutaneous coronarypostoperative complicationshemorrhagerisk factorsprognosismortalityfibrinolytic agents |
| spellingShingle | Matić Dragan M. Ašanin Milika R. Stanković Sanja Đ. Mrdović Igor B. Marinković Jelena M. Kočev Nikola I. Antonijević Nebojša M. Marjanović Marija M. Nešić Zorica I. Prostran Milica S. Stanković Goran R. Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention Vojnosanitetski Pregled angioplasty, transluminal, percutaneous coronary postoperative complications hemorrhage risk factors prognosis mortality fibrinolytic agents |
| title | Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| title_full | Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| title_fullStr | Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| title_full_unstemmed | Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| title_short | Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| title_sort | incidence predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention |
| topic | angioplasty, transluminal, percutaneous coronary postoperative complications hemorrhage risk factors prognosis mortality fibrinolytic agents |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400064M.pdf |
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