OBJECTIVES: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. METHODS: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. RESULTS: An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001). CONCLUSIONS: The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.
OBJECTIVES: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown. METHODS: Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant ± glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio. RESULTS: An approximate 20% reduction in post-PCI bleeding was seen (elective PCI: 1.4% to 1.1%; UA/NSTEMI: 2.3% to 1.8; STEMI: 4.9% to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44% to 49%. Bivalirudin use increased (17% to 30%), whereas any heparin + GPI decreased (41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5% to 4% for elective PCI, and 5.7% to 2.8% for UA/NSTEMI (both p <0.001). CONCLUSIONS: The nearly 20% reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.
Authors: R G Brindis; S Fitzgerald; H V Anderson; R E Shaw; W S Weintraub; J F Williams Journal: J Am Coll Cardiol Date: 2001-06-15 Impact factor: 24.094
Authors: Matthew T Roe; John C Messenger; William S Weintraub; Christopher P Cannon; Gregg C Fonarow; David Dai; Anita Y Chen; Lloyd W Klein; Frederick A Masoudi; Charles McKay; Kathleen Hewitt; Ralph G Brindis; Eric D Peterson; John S Rumsfeld Journal: J Am Coll Cardiol Date: 2010-07-20 Impact factor: 24.094
Authors: A Michael Lincoff; John A Bittl; Robert A Harrington; Frederick Feit; Neal S Kleiman; J Daniel Jackman; Ian J Sarembock; David J Cohen; Douglas Spriggs; Ramin Ebrahimi; Gadi Keren; Jeffrey Carr; Eric A Cohen; Amadeo Betriu; Walter Desmet; Dean J Kereiakes; Wolfgang Rutsch; Robert G Wilcox; Pim J de Feyter; Alec Vahanian; Eric J Topol Journal: JAMA Date: 2003-02-19 Impact factor: 56.272
Authors: Daniel W Mudrick; Anita Y Chen; Matthew T Roe; L Kristin Newby; W Brian Gibler; E Magnus Ohman; Eric D Peterson; Karen P Alexander Journal: Am Heart J Date: 2010-12 Impact factor: 4.749
Authors: Basem Elbarouni; Omran Elmanfud; Raymond T Yan; Keith A A Fox; Jan M Kornder; Barry Rose; Frederick A Spencer; Robert C Welsh; Graham C Wong; Shaun G Goodman; Andrew T Yan Journal: Am Heart J Date: 2010-09 Impact factor: 4.749
Authors: Steven P Marso; Amit P Amin; John A House; Kevin F Kennedy; John A Spertus; Sunil V Rao; David J Cohen; John C Messenger; John S Rumsfeld Journal: JAMA Date: 2010-06-02 Impact factor: 56.272
Authors: Sanjit S Jolly; Salim Yusuf; John Cairns; Kari Niemelä; Denis Xavier; Petr Widimsky; Andrzej Budaj; Matti Niemelä; Vicent Valentin; Basil S Lewis; Alvaro Avezum; Philippe Gabriel Steg; Sunil V Rao; Peggy Gao; Rizwan Afzal; Campbell D Joyner; Susan Chrolavicius; Shamir R Mehta Journal: Lancet Date: 2011-04-04 Impact factor: 79.321
Authors: Neil J Wimmer; Eric A Secemsky; Laura Mauri; Matthew T Roe; Paramita Saha-Chaudhuri; David Dai; James M McCabe; Frederic S Resnic; Hitinder S Gurm; Robert W Yeh Journal: Circ Cardiovasc Interv Date: 2016-04 Impact factor: 6.546
Authors: Kristal Young; Thomas Earl; Faith Selzer; Oscar C Marroquin; Suresh R Mulukutla; Howard A Cohen; David O Williams; Alice Jacobs; Sheryl F Kelsey; J Dawn Abbott Journal: Am J Cardiol Date: 2013-11-23 Impact factor: 2.778
Authors: Ernesto Ruiz-Rodriguez; Ahmed Asfour; Georges Lolay; Khaled M Ziada; Ahmed K Abdel-Latif Journal: South Med J Date: 2016-01 Impact factor: 0.954
Authors: John P Vavalle; Robert Clare; Karen Chiswell; Sunil V Rao; John L Petersen; Neal S Kleiman; Kenneth W Mahaffey; Tracy Y Wang Journal: JACC Cardiovasc Interv Date: 2013-07 Impact factor: 11.195