In a study that included 3.3 million percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) procedures, major bleeding after PCI was associated with significantly increased in-hospital mortality, with an estimated 12 percent of deaths after PCI related to bleeding complications, according to a study appearing in the March 13 issue of JAMA.
"Bleeding represents the most common noncardiac complication of PCI. Postprocedural bleeding is associated with short- and long-term death, nonfatal myocardial infarction, stroke, blood transfusion, prolonged hospital stay, rehospitalization, and increased hospital costs. Post-PCI bleeding is predictable, using tools such as the bleeding risk algorithm derived from the CathPCI Registry. Bleeding risk is modifiable through the use of established bleeding avoidance strategies such as bivalirudin anticoagulation, arterial closure devices, and radial artery access," according to background information in the article. "The incidence of bleeding-related mortality after PCI has not been described in a nationally representative population. Furthermore, the relationships among bleeding risk, bleeding site, and mortality are unclear."
Adnan K. Chhatriwalla, M.D., of Saint Luke's Mid America Heart Institute, Kansas City, Mo., and colleagues conducted a study to estimate the adjusted population attributable risk of bleeding-related mortality in the U.S. PCI population. The study included data from 3,386,688 procedures in the CathPCI Registry performed in the United States between 2004 and 2011. The population attributable risk was calculated after adjustment for baseline demographic, clinical, and procedural variables. Also, the number needed to harm (NNH) for bleeding-related mortality was calculated.