Correlates of poor outcome among patients with bleeding after coronary interventions

Ndrepepa, G; Guerra, E; Schulz, S; Hoppmann, P; Laugwitz, KL; Kastrati, A

journal article

Title:: Correlates of poor outcome among patients with bleeding after coronary interventions
Document type:: Article
Author(s):: Ndrepepa, G; Guerra, E; Schulz, S; Hoppmann, P; Laugwitz, KL; Kastrati, A
Abstract:: Objectives The objective of this study was to identify factors associated with the increased risk of mortality among patients with bleeding complications during percutaneous coronary intervention (PCI). Methods The study included 1510 patients with periprocedural bleeding complications of the 14 180 patients undergoing PCI. Bleeding was defined and scaled according to the Bleeding Academic Research Consortium criteria. The main outcome was all-cause mortality at 1 year after PCI. Results Of the 1510 patients with bleeding within the first 30 days of PCI, 104 patients (6.9%) died during the first year after PCI. One-year survival according to the Bleeding Academic Research Consortium classes was as follows: 96.4% (22 deaths) in class 1, 94.7% (12 deaths) in class 2, 91.0% (42 deaths) in class 3a, 85.4% (23 deaths) in class 3b, and 58.3% (five deaths) in class 3c (P< 0.001). The Cox proportional hazards model identified bleeding severity [hazard ratio (HR)=1.55, 95% confidence interval 1.25-1.93 for one class increase in bleeding scale, P< 0.001], bleeding site [HR=1.79 (1.18-2.71) for nonaccess vs. access site, P=0.006], elevated troponin levels [HR=1.66 (1.09-2.53), P=0.018], multivessel disease [HR=2.15 (1.01-4.56), P=0.047], C-reactive protein [HR=1.04 (1.01-1.06) for 5mg/l increase, P=0.002], anemia [HR=2.27 (1.39-3.71) for 4 g/dl decrease in hemoglobin, P=0.001], and platelet count [HR=1.11 (1.02-1.21) for 50 x 10(9) /l increase in platelet count, P=0.013] as independent associates of mortality. Age (P=0.072) and reduced estimated creatinine clearance (P=0.066) were close to reaching statistical significance as associates of mortality. Conclusion Among patients with peri-PCI bleeding, the characteristics of bleeding itself and the cardiovascular risk profile underlie the increased risk for poor outcome after PCI. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Journal title abbreviation:: Coron Artery Dis
Year:: 2014
Journal volume:: 25
Journal issue:: 6
Pages contribution:: 456-462
Language:: eng
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/24801558
Print-ISSN:: 0954-6928
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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Occurrences:

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2014

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2014