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Late mortality risk elevated in patients with nonaccess site bleeding after PCI
The rate of late mortality after primary PCI was greater in patients with nonaccess site bleeding compared with PCI recipients with access site bleeding, according to findings published in Heart.
In addition, both access and nonaccess site bleeding were independently associated with high risk for long-term mortality after PCI.
Dragan M. Matic, MD, PhD, and colleagues investigated the relationship between in-hospital access site vs. nonaccess site bleeding and very late mortality in unselected patients treated with primary PCI.
“Randomized trials have demonstrated that patients with major bleeding complicating acute coronary syndromes undergoing PCI have worse clinical outcomes than those without bleeding,” Matic, of the emergency department at the Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine at University of Belgrade in Serbia, and colleagues wrote. “The results of studies reporting the impact of bleeding location on clinical outcomes generally indicate a greater risk of subsequent mortality in patients with nonaccess site bleeding, while data on the impact of access site bleeding on 1-year mortality are not consistent.”
The researchers analyzed data of 2,715 consecutive patients with STEMI treated with primary PCI, enrolled in a prospective registry of a high-volume tertiary center.
Bleeding events were assessed according to Bleeding Academic Research Consortium (BARC) criteria.
The primary outcome was 4-year mortality, Matic and colleagues wrote.
The researchers found BARC type 2 or greater bleeding occurred in 6.3% of patients (median age, 66 years). Access site bleeding was more common than nonaccess site bleeding (3.8% vs. 2.5%), Matic and colleagues wrote. Four-year mortality was higher for patients with BARC type 2 or greater bleeding than in patients without bleeding (36.3% vs. 16.2%; P < .001).
Patients with nonaccess site bleeding had greater 4-year mortality (50.7% vs. 26.5%, P = .001), the researchers wrote.
BARC type 2 or greater bleeding was the independent predictor of 4-year mortality after multivariable adjustment (HR = 2.01; 95% CI, 1.49-2.71), Matic and colleagues wrote.
There was a twofold higher risk for very late mortality in patients with nonaccess site access bleeding compared with patients with access site bleeding (HR = 2.62; 95% CI, 1.78-3.86 vs. HR = 1.57; 95% CI, 1.03-2.38), the researchers wrote.
“New measures for the estimation of the individual risk for bleeding for each patient undergoing primary PCI should be implemented in regular clinical practice to reduce bleeding complications and mortality,” Matic and colleagues wrote. “Reduction of access site bleeding by radial access cannot resolve the problem of higher mortality of patients and optimization of the level of antithrombotic treatment is still of central importance.” – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.