Chun Shing Kwok1, Evangelos Kontopantelis1, Tim Kinnaird1, Jessica Potts1, Muhammad Rashid1, Ahmad Shoaib1, James Nolan1, Rodrigo Bagur1, Mark A de Belder1, Peter Ludman1, Mamas A Mamas2. 1. From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.). 2. From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.). mamasmamas1@yahoo.co.uk.
Abstract
BACKGROUND: Retroperitoneal hemorrhage (RH) is a rare bleeding complication of percutaneous coronary intervention, which can result as a consequence of femoral access or can occur spontaneously. This study aims to evaluate temporal changes in RH, its predictors, and clinical outcomes in a national cohort of patients undergoing percutaneous coronary intervention in the United Kingdom. METHODS AND RESULTS: We analyzed RH events in patients who underwent percutaneous coronary intervention between 2007 and 2014. Multiple logistic regression models were used to identify factors associated with RH and to quantify the association between RH and 30-day mortality and major adverse cardiovascular events. A total of 511 106 participants were included, and 291 in hospital RH events were recorded (0.06%). Overall, rates of RH declined from 0.09% to 0.03% between 2007 and 2014. The strongest independent predictors of RH events were femoral access (odds ratio [OR], 19.66; 95% confidence interval [CI], 11.22-34.43), glycoprotein IIb/IIIa inhibitor (OR, 2.63; 95% CI, 1.99-3.47), and warfarin use (OR, 2.53; 95% CI, 1.07-5.99). RH was associated with a significant increase in 30-day mortality (OR, 3.59; 95% CI, 2.19-5.90) and in-hospital major adverse cardiovascular events (OR, 5.76; 95% CI, 3.71-8.95). A legacy effect was not observed; patients with RH who survived 30 days did not have higher 1-year mortality compared with those without this complication (hazard ratio, 0.97; 95% CI, 0.49-1.91). CONCLUSIONS: Our results suggest that RH is a rare event that is declining in the United Kingdom, related to transition to transradial access site utilization, but remains a clinically important event associated with increased 30-day mortality but no long-term legacy effect.
BACKGROUND:Retroperitoneal hemorrhage (RH) is a rare bleeding complication of percutaneous coronary intervention, which can result as a consequence of femoral access or can occur spontaneously. This study aims to evaluate temporal changes in RH, its predictors, and clinical outcomes in a national cohort of patients undergoing percutaneous coronary intervention in the United Kingdom. METHODS AND RESULTS: We analyzed RH events in patients who underwent percutaneous coronary intervention between 2007 and 2014. Multiple logistic regression models were used to identify factors associated with RH and to quantify the association between RH and 30-day mortality and major adverse cardiovascular events. A total of 511 106 participants were included, and 291 in hospital RH events were recorded (0.06%). Overall, rates of RH declined from 0.09% to 0.03% between 2007 and 2014. The strongest independent predictors of RH events were femoral access (odds ratio [OR], 19.66; 95% confidence interval [CI], 11.22-34.43), glycoprotein IIb/IIIa inhibitor (OR, 2.63; 95% CI, 1.99-3.47), and warfarin use (OR, 2.53; 95% CI, 1.07-5.99). RH was associated with a significant increase in 30-day mortality (OR, 3.59; 95% CI, 2.19-5.90) and in-hospital major adverse cardiovascular events (OR, 5.76; 95% CI, 3.71-8.95). A legacy effect was not observed; patients with RH who survived 30 days did not have higher 1-year mortality compared with those without this complication (hazard ratio, 0.97; 95% CI, 0.49-1.91). CONCLUSIONS: Our results suggest that RH is a rare event that is declining in the United Kingdom, related to transition to transradial access site utilization, but remains a clinically important event associated with increased 30-day mortality but no long-term legacy effect.
Authors: Paraskevi Taxiarchi; Evangelos Kontopantelis; Tim Kinnaird; Nick Curzen; Adrian Banning; Peter Ludman; Ahmad Shoaib; Muhammad Rashid; Glen P Martin; Mamas A Mamas Journal: Int J Cardiol Date: 2020-07-30 Impact factor: 4.164
Authors: Nadjib Schahab; Refik Kavsur; Thorsten Mahn; Christian Schaefer; Alexander Kania; Rolf Fimmers; Georg Nickenig; Sebastian Zimmer Journal: PLoS One Date: 2020-03-19 Impact factor: 3.240
Authors: Muhammad Rashid Hons; Chris P Gale Hons; Nick Curzen Hons; Peter Ludman Hons; Mark De Belder Hons; Adam Timmis Hons; Mohamed O Mohamed Hons; Thomas F Lüscher Hons; Julian Hains Hons; Jianhua Wu; Ahmad Shoaib; Evangelos Kontopantelis; Chris Roebuck; Tom Denwood; John Deanfield; Mamas A Mamas Journal: J Am Heart Assoc Date: 2020-10-07 Impact factor: 5.501