Abstract 3918: Chronic Renal Insufficiency and Bleeding Risk after Percutaneous Coronary Intervention: A Continuous rather than a “Threshold” Relationship
Background: Prior studies have shown a relationship between renal insufficiency and an increased risk of bleeding following PCI. It is however unclear whether this relationship is continuous, or whether there is a threshold level.
Methods: We stratified 61,532 patients enrolled in a large, multicenter, prospective, validated, regional PCI registry into four groups based on preprocedure creatinine clearance (CrCl) of >90, 60 – 89, 30–59, and <30 ml/min using the Cockroft-Gault equation. Patients undergoing dialysis prior to PCI were excluded. The risks of post-procedure gastrointestinal (GI) bleeding, transfusion, and vascular complications were compared between groups.
Results: In this large PCI registry, 45%, 31%, 21%, and 2% of patients had CrCl of >90, 60 – 89, 30–59, and <30 ml/min respectively. The rates of GI bleeding, transfusions and vascular complications increased significantly with worsening CrCl (Figure⇓). After adjustment for comorbidities, reduced CrCl was independently predictive of GI bleeding and transfusions but not vascular complications (Table⇓).
Conclusions: GI bleeding, transfusion rates, and vascular complications increase in a linear relationship with worsening renal insufficiency. In addition, even mild degrees of renal insufficiency are associated with an increased risk of bleeding following PCI.