TY - JOUR
T1 - Prognostic value of access site and nonaccess site bleeding after percutaneous coronary intervention
T2 - A cohort study in ST-segment elevation myocardial infarction and comprehensive meta-analysis
AU - Kikkert, Wouter J.
AU - Delewi, Ronak
AU - Ouweneel, Dagmar M.
AU - Van Nes, Sophie H.
AU - Vis, Marije M.
AU - Baan, Jan
AU - Koch, Karel T.
AU - Dangas, George D.
AU - Mehran, Roxana
AU - De Winter, Robbert J.
AU - Peters, Ron J.G.
AU - Piek, Jan J.
AU - Tijssen, Jan G.P.
AU - Henriques, Jose P.S.
N1 - Funding Information:
This work was supported by The Nuts OHRA Foundation , the Netherlands ( SNO-T-0702-61 ). Dr. Mehran has received institutional research grant support from The Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly/Daiichi Sankyo ; is a consultant for Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, CSL Behring, Janssen Pharmaceuticals, Maya Medical, Merck & Co., Regado Biosciences, and Sanofi-Aventis; is on the advisory board of Covidien, Janssen Pharmaceuticals, and Sanofi-Aventis; and has equity and is a shareholder in Endothelix, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/6
Y1 - 2014/6
N2 - Objectives This study sought to investigate the prognostic value of access site bleeding (ASB) and non-ASB for recurrent ischemic outcomes and mortality in patients with ST-segment elevation myocardial infarction (STEMI). Background The prognostic value of ASB-related complications after STEMI is subject to debate. Methods The prognostic value of ASB and non-ASB for 1-year mortality, recurrent myocardial infarction (MI), stent thrombosis, and stroke was investigated in 2,002 STEMI patients undergoing primary percutaneous coronary intervention. In addition, we performed a meta-analysis of studies investigating the prognostic value of ASB and non-ASB in patients undergoing percutaneous coronary intervention. Results Seventy-four patients (3.7%) were treated by radial access. ASB developed in 124 patients (6.3%) and non-ASB developed in 102 (5.2%). By multivariable analysis, ASB was not associated with a higher risk of 1-year mortality (hazard ratio [HR]: 1.03; p = 0.89), recurrent MI (HR: 1.16; p = 0.64), stent thrombosis (HR: 0.55; p = 0.42), or stroke (HR: 0.47; p = 0.31). Non-ASB was independently associated with 1-year mortality (HR: 2.77; p < 0.001) and stent thrombosis (HR: 3.10; p = 0.021), but not with recurrent MI and stroke. In a meta-analysis including 495,630 patients, non-ASB was associated with a greater adjusted risk of subsequent 1-year mortality than ASB (HR: 1.66; 95% CI: 1.56 to 1.76 and HR: 1.21; 95% CI: 1.11 to 1.31). Conclusions In STEMI, ASB was not significantly associated with 1-year clinical outcomes, whereas non-ASB was significantly associated with 1-year mortality and stent thrombosis. These results taken together with those of previous studies indicate a greater risk of subsequent mortality in patients with non-ASB.
AB - Objectives This study sought to investigate the prognostic value of access site bleeding (ASB) and non-ASB for recurrent ischemic outcomes and mortality in patients with ST-segment elevation myocardial infarction (STEMI). Background The prognostic value of ASB-related complications after STEMI is subject to debate. Methods The prognostic value of ASB and non-ASB for 1-year mortality, recurrent myocardial infarction (MI), stent thrombosis, and stroke was investigated in 2,002 STEMI patients undergoing primary percutaneous coronary intervention. In addition, we performed a meta-analysis of studies investigating the prognostic value of ASB and non-ASB in patients undergoing percutaneous coronary intervention. Results Seventy-four patients (3.7%) were treated by radial access. ASB developed in 124 patients (6.3%) and non-ASB developed in 102 (5.2%). By multivariable analysis, ASB was not associated with a higher risk of 1-year mortality (hazard ratio [HR]: 1.03; p = 0.89), recurrent MI (HR: 1.16; p = 0.64), stent thrombosis (HR: 0.55; p = 0.42), or stroke (HR: 0.47; p = 0.31). Non-ASB was independently associated with 1-year mortality (HR: 2.77; p < 0.001) and stent thrombosis (HR: 3.10; p = 0.021), but not with recurrent MI and stroke. In a meta-analysis including 495,630 patients, non-ASB was associated with a greater adjusted risk of subsequent 1-year mortality than ASB (HR: 1.66; 95% CI: 1.56 to 1.76 and HR: 1.21; 95% CI: 1.11 to 1.31). Conclusions In STEMI, ASB was not significantly associated with 1-year clinical outcomes, whereas non-ASB was significantly associated with 1-year mortality and stent thrombosis. These results taken together with those of previous studies indicate a greater risk of subsequent mortality in patients with non-ASB.
KW - ST-segment elevation myocardial infarction
KW - major bleeding
KW - percutaneous coronary intervention
KW - primary percutaneous coronary intervention
KW - vascular access site
UR - https://www.scopus.com/pages/publications/84902885923
U2 - 10.1016/j.jcin.2014.01.162
DO - 10.1016/j.jcin.2014.01.162
M3 - Article
C2 - 24835321
AN - SCOPUS:84902885923
SN - 1936-8798
VL - 7
SP - 622
EP - 630
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 6
ER -