Abstract 1932: Bleeding and Vascular Complications Following Percutaneous Coronary Intervention can be Reduced with Multiple Practice Changes
Background: Bleeding (BC) and vascular complications (VC) remain an important cause of post-PCI morbidity and mortality that are potentially avoidable. We implemented a series of practice changes to reduce the risk of BC and VC and hypothesized they would be significantly associated with a decreased risk of these adverse events.
Methods: Data were prospectively collected on 5916 consecutive patient admissions comprising 6019 PCIs from 1/2002–9/2006 at the Dartmouth-Hitchcock Medical Center. During that time period practice changes included routine fluoroscopy-guided femoral puncture, routine femoral angiography, selective use of closure devices, increased use of bivalirudin, decreased use of IIb/IIIa inhibitors, use of a dedicated recovery unit. Logistic regression was used to examine the relationship between changing practices, BC, and VC, controlling for case-mix, with results reported as adjusted odds ratios (OR) with 95% confidence intervals.
Results: Between 2002 and 2006 BC rates decreased from 5.95% to 4.42% (p=0.006) and VC rates from 0.47% to 0.09% (p=0.070). The risk of BC decreased significantly with the use of bivalirudin, femoral angiography, suture-mediated closure, and use of a recovery unit (Table⇓). VC decreased significantly with the use of closure devices.
Conclusions: Procedural and process changes made in the care of patients undergoing PCI were significantly associated with decreasing the risk of BC and VC.