Incidence and prognostic value of bleeding after percutaneous coronary intervention in patients older than 75 years of age. Issue 2 (19th October 2013)

• Record Type: Journal Article
• Authors: Ndrepepa, Gjin; Neumann, Franz‐Josef; Schulz, Stefanie; Fusaro, Massimiliano; Cassese, Salvatore; Byrne, Robert A.; Richardt, Gert; Laugwitz, Karl‐Ludwig; Kastrati, Adnan
• Is Part Of: Catheterization and cardiovascular interventions. Volume 83:Issue 2(2014:Feb. 01)
• Page Start: 182
• Page End: 189
• Publication Date: 2013-10-19
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25189
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25189-sec-0001" sec-type="section"> <title>Objectives</title> <p>We aimed to assess the impact of bleeding after percutaneous coronary intervention (PCI) on the outcome of patients >75 years of age.</p> </sec> <sec id="ccd25189-sec-0002" sec-type="section"> <title>Background</title> <p>Limited information exists on the impact of post‐PCI bleeding on the outcome in elderly patients.</p> </sec> <sec id="ccd25189-sec-0003" sec-type="section"> <title>Methods</title> <p>This study included 3, 255 patients >75 years of age. Bleeding events were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1‐year mortality.</p> </sec> <sec id="ccd25189-sec-0004" sec-type="section"> <title>Results</title> <p>Within 30 days after PCI, bleeding occurred in 501 patients (15.4%). Bleeding according to BARC was: class 1 (170 patients; 33.9%), class 2 (81 patients; 16.2%), class 3a (177 patients; 35.3%), class 3b (65 patients; 13.0%), class 3c (four patients; 0.8%), and class 4 (four patients; 0.8%). There were 201 deaths within the first year after PCI: 61 deaths (12.3%) among bleeders and 140 deaths (5.1%) among nonbleeders (adjusted hazard ratio = 2.03, 95% confidence interval [CI] 1.42–2.91, <italic>P</italic> < 0.001). Bleeding improved the discriminatory power of multivariable model for mortality prediction (<italic>P</italic> = 0.001). Female sex (adjusted odds ratio [OR] = 1.49 [1.17–1.88], <italic>P</italic> = 0.001) and reduced renal function (adjusted OR = 1.30 [1.04–1.63], <italic>P</italic> = 0.019 for each 30 ml/min decrease in the creatinine clearance) were independent associates of increased bleeding risk. Bivalirudin reduced the bleeding risk by 24% compared with unfractionated heparin and 33% compared with abciximab plus unfractionated heparin.</p> </sec> <sec id="ccd25189-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Post‐PCI bleeding is an important prognostic factor in patients >75 years of age. The risk for bleeding in this age category is increased in women and patients with impaired renal function. Bleeding risk is reduced by bivalirudin. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>