NCDR Study Shows Bleeding Associated With In-Hospital Mortality Following PCI

Major bleeding events are associated with significantly increased in-hospital mortality following percutaneous coronary intervention (PCI), according to a study published on March 12 in the Journal of the American Medical Association.

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The study looked at 3,386,688 procedures from the NCDR® CathPCI Registry®, and within the cohort, there were 57,246 major bleeding events (1.69 percent; 95 percent CI, 1.68 percent - 1.70 percent) and 22,165 in-hospital deaths (0.65 percent; 95 percent CI, 64 percent - 0.66 percent). The study found that the adjusted population attributable risk of in-hospital mortality related to major bleeding was 12.1 percent (95 percent CI, 11.4 percent – 12.7 percent). Further, in a propensity-matched population of 56,078 procedures with a major bleeding event and 224,312 controls, major bleeding was associated with increased in-hospital mortality when compared to those without bleeding (5.26 percent vs. 1.87 percent; risk difference, 3.39 percent [95 percent CI, 3.20 percent-3.59 percent]; number needed to harm (NNH)=29 [95 percent CI, 28-31]; P<.001).

The authors note that post-procedural bleeding remains a common complication following PCI, and increases cost and length of hospitalization. "These findings … suggest that bleeding avoidance strategies are of greatest benefit and therefore should be preferentially used in higher-risk patients to reduce the risk of major bleeding complications and bleeding-rate mortality after PCI," the authors conclude. Further, "these data also affirm the importance of using validated risk assessment tools to accurately estimate bleeding risk and guide treatment strategy for all patients undergoing PCI," they add.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Registries, Hospital Mortality, Risk Assessment, Hospitalization, Hemorrhage, United States, Percutaneous Coronary Intervention

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