Temporal Trends in and Factors Associated With Bleeding Complications Among Patients Undergoing Percutaneous Coronary Intervention: A Report From the National Cardiovascular Data CathPCI Registry

Study Questions:

What are the temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI)?

Methods:

The authors evaluated temporal trends in post-PCI bleeding from 2005 to 2009 among patients enrolled in the NCDR CathPCI Registry® with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632).

Results:

During the study period, there was an approximate 20% reduction in post-PCI bleeding. Bleeding decreased in elective PCI from 1.4% to 1.1%, in UA/NSTEMI from 2.3% to 1.8% and in STEMI from 4.9% to 4.5%. There was an increase in bivalirudin use (from 17% to 30%), and a decrease in the use of heparin + glycoprotein IIb/IIIa inhibitor use (from 41% to 28%). There was a significant 6% to 8% per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Use of the radial approach was low and closure device use increased slightly from 44% to 49%. Change in antithrombotic strategies was associated with roughly one-half of the reduction in annual bleeding risk in both elective PCI as well as patients with UA/NSTEMI.

Conclusions:

There has been a 20% reduction in post-PCI bleeding over the study duration, and this was mostly related to changes in antithrombotic strategies.

Perspective:

The decline in bleeding post-PCI seen in this study is encouraging, although there is still room for further improvement. In this study, most of the reduction in bleeding was secondary to changes in antithrombotic strategy. Radial access is the most effective strategy at reducing access site complications and is finally being adopted around the country. It will be interesting to see if wider use of the radial approach will be associated with a sharper decline in bleeding complications.

Clinical Topics: Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention

Keywords: Registries, Myocardial Infarction, Heparin, Cardiovascular Diseases, Recombinant Proteins, Peptide Fragments, Angioplasty, Hirudins, Hemorrhage, Percutaneous Coronary Intervention, Platelet Glycoprotein GPIIb-IIIa Complex


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