Bleeding severity after percutaneous coronary intervention

Björn Redfors, Philippe Généreux, Bernhard Witzenbichler, Ajay J. Kirtane, Thomas McAndrew, Giora Weisz, Thomas D. Stuckey, Timothy D. Henry, Akiko Maehara, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

Abstract

Background—In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (ΔHgb), on the risk of death and other adverse events. Methods and Results—We studied the association between ΔHgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Post-percutaneous coronary intervention, 5985 (78.7%) patients had a drop in Hgb, with 2684 patients (35.3%) having a ΔHgb <1.0 g/dL, 2338 (30.7%) ≥1.0 to <2.0 g/dL, 745 (9.8%) ≥2.0 to <3.0 g/dL, 145 (1.9%) ≥3.0 to <4.0 g/dL, and 73 (1.0%) ≥4.0 g/dL. The risk of dying within 2 years was 3.3% with <1.0 g/dL ΔHgb, 3.4% with ΔHgb ≥1.0 to <2.0 g/dL, 3.7% with ΔHgb ≥2.0 to <3.0 g/dL, 4.1% with ΔHgb ≥3.0 to <4.0 g/dL, and 9.8% with ΔHgb ≥4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with ΔHgb ≥4.0 g/dL (adjusted hazard ratio, 3.39; 95% confidence interval, 1.97–5.83; P<0.001) and for patients with ΔHgb ≥3.0 to <4.0 g/dL (adjusted hazard ratio, 2.17; 95% confidence interval, 1.34–3.53; P=0.002). Conclusions—Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in ΔHgb ≥4.0 g/dL are associated with a considerably increased risk of dying.

Original languageEnglish (US)
Article numbere005542
JournalCirculation: Cardiovascular Interventions
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

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Percutaneous Coronary Intervention
Hemoglobins
Hemorrhage
Confidence Intervals
Drug-Eluting Stents
Stents
Registries
Thrombosis
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, B., Généreux, P., Witzenbichler, B., Kirtane, A. J., McAndrew, T., Weisz, G., ... Stone, G. W. (2018). Bleeding severity after percutaneous coronary intervention. Circulation: Cardiovascular Interventions, 11(3), [e005542]. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005542
Redfors, Björn ; Généreux, Philippe ; Witzenbichler, Bernhard ; Kirtane, Ajay J. ; McAndrew, Thomas ; Weisz, Giora ; Stuckey, Thomas D. ; Henry, Timothy D. ; Maehara, Akiko ; Mehran, Roxana ; Stone, Gregg W. / Bleeding severity after percutaneous coronary intervention. In: Circulation: Cardiovascular Interventions. 2018 ; Vol. 11, No. 3.
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abstract = "Background—In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (ΔHgb), on the risk of death and other adverse events. Methods and Results—We studied the association between ΔHgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Post-percutaneous coronary intervention, 5985 (78.7{\%}) patients had a drop in Hgb, with 2684 patients (35.3{\%}) having a ΔHgb <1.0 g/dL, 2338 (30.7{\%}) ≥1.0 to <2.0 g/dL, 745 (9.8{\%}) ≥2.0 to <3.0 g/dL, 145 (1.9{\%}) ≥3.0 to <4.0 g/dL, and 73 (1.0{\%}) ≥4.0 g/dL. The risk of dying within 2 years was 3.3{\%} with <1.0 g/dL ΔHgb, 3.4{\%} with ΔHgb ≥1.0 to <2.0 g/dL, 3.7{\%} with ΔHgb ≥2.0 to <3.0 g/dL, 4.1{\%} with ΔHgb ≥3.0 to <4.0 g/dL, and 9.8{\%} with ΔHgb ≥4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with ΔHgb ≥4.0 g/dL (adjusted hazard ratio, 3.39; 95{\%} confidence interval, 1.97–5.83; P<0.001) and for patients with ΔHgb ≥3.0 to <4.0 g/dL (adjusted hazard ratio, 2.17; 95{\%} confidence interval, 1.34–3.53; P=0.002). Conclusions—Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in ΔHgb ≥4.0 g/dL are associated with a considerably increased risk of dying.",
author = "Bj{\"o}rn Redfors and Philippe G{\'e}n{\'e}reux and Bernhard Witzenbichler and Kirtane, {Ajay J.} and Thomas McAndrew and Giora Weisz and Stuckey, {Thomas D.} and Henry, {Timothy D.} and Akiko Maehara and Roxana Mehran and Stone, {Gregg W.}",
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Redfors, B, Généreux, P, Witzenbichler, B, Kirtane, AJ, McAndrew, T, Weisz, G, Stuckey, TD, Henry, TD, Maehara, A, Mehran, R & Stone, GW 2018, 'Bleeding severity after percutaneous coronary intervention', Circulation: Cardiovascular Interventions, vol. 11, no. 3, e005542. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005542

Bleeding severity after percutaneous coronary intervention. / Redfors, Björn; Généreux, Philippe; Witzenbichler, Bernhard; Kirtane, Ajay J.; McAndrew, Thomas; Weisz, Giora; Stuckey, Thomas D.; Henry, Timothy D.; Maehara, Akiko; Mehran, Roxana; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 11, No. 3, e005542, 01.03.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bleeding severity after percutaneous coronary intervention

AU - Redfors, Björn

AU - Généreux, Philippe

AU - Witzenbichler, Bernhard

AU - Kirtane, Ajay J.

AU - McAndrew, Thomas

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Henry, Timothy D.

AU - Maehara, Akiko

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background—In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (ΔHgb), on the risk of death and other adverse events. Methods and Results—We studied the association between ΔHgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Post-percutaneous coronary intervention, 5985 (78.7%) patients had a drop in Hgb, with 2684 patients (35.3%) having a ΔHgb <1.0 g/dL, 2338 (30.7%) ≥1.0 to <2.0 g/dL, 745 (9.8%) ≥2.0 to <3.0 g/dL, 145 (1.9%) ≥3.0 to <4.0 g/dL, and 73 (1.0%) ≥4.0 g/dL. The risk of dying within 2 years was 3.3% with <1.0 g/dL ΔHgb, 3.4% with ΔHgb ≥1.0 to <2.0 g/dL, 3.7% with ΔHgb ≥2.0 to <3.0 g/dL, 4.1% with ΔHgb ≥3.0 to <4.0 g/dL, and 9.8% with ΔHgb ≥4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with ΔHgb ≥4.0 g/dL (adjusted hazard ratio, 3.39; 95% confidence interval, 1.97–5.83; P<0.001) and for patients with ΔHgb ≥3.0 to <4.0 g/dL (adjusted hazard ratio, 2.17; 95% confidence interval, 1.34–3.53; P=0.002). Conclusions—Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in ΔHgb ≥4.0 g/dL are associated with a considerably increased risk of dying.

AB - Background—In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (ΔHgb), on the risk of death and other adverse events. Methods and Results—We studied the association between ΔHgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Post-percutaneous coronary intervention, 5985 (78.7%) patients had a drop in Hgb, with 2684 patients (35.3%) having a ΔHgb <1.0 g/dL, 2338 (30.7%) ≥1.0 to <2.0 g/dL, 745 (9.8%) ≥2.0 to <3.0 g/dL, 145 (1.9%) ≥3.0 to <4.0 g/dL, and 73 (1.0%) ≥4.0 g/dL. The risk of dying within 2 years was 3.3% with <1.0 g/dL ΔHgb, 3.4% with ΔHgb ≥1.0 to <2.0 g/dL, 3.7% with ΔHgb ≥2.0 to <3.0 g/dL, 4.1% with ΔHgb ≥3.0 to <4.0 g/dL, and 9.8% with ΔHgb ≥4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with ΔHgb ≥4.0 g/dL (adjusted hazard ratio, 3.39; 95% confidence interval, 1.97–5.83; P<0.001) and for patients with ΔHgb ≥3.0 to <4.0 g/dL (adjusted hazard ratio, 2.17; 95% confidence interval, 1.34–3.53; P=0.002). Conclusions—Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in ΔHgb ≥4.0 g/dL are associated with a considerably increased risk of dying.

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