Abstract 987: Incidence, Predictors and Clinical Impact of Bleeding after Transradial Coronary Stenting and Maximal Antiplatelet Therapy
Background: Bleeding after percutaneous coronary intervention (PCI) using femoral approach has recently emerged as an independent risk factor of early and late mortality. Transradial PCI is associated with a lower risk of access site complications than femoral approach. We sought to determine the predictors of bleeding and evaluate the impact of major bleeding on death and major adverse cardiac events (MACE) after transradial PCI and maximal antiplatelet therapy.
Methods: In the EASY trial, 1348 acute coronary syndrome patients were enrolled and underwent transradial PCI. All patients received clopidogrel (90% ≥ 12h pre-PCI) and a bolus of abciximab prior to first balloon inflation. Independent predictors and prognostic impact of major bleeding on death and MACE (death, MI and TVR) were assessed using multivariate analysis.
Results: From the study population, 19 patients (1.4%) presented major bleeding. Among baseline characteristics only creatinine clearance < 60 ml/min was an independent predictor of bleeding (Odds Ratio (OR) 3.49, 95% CI 1.17–9.48, P = 0.017). Peri-procedural independent predictors of bleeding were procedure duration (OR 3.42, 95% CI 1.25–10.31, P = 0.020) and sheath size (OR 4.98, 95% CI 1.33–32.36, p = 0.038). In patients with major bleeding, the incidence of MACE was higher at 30 days (37% vs. 3%), 6 months (42% vs. 8%) and at 12 months (53% vs. 12%), P < 0.0001 for all comparisons. By multivariate analysis, major bleeding was an independent predictive factor of 1-year mortality and MACE.
Conclusion: After transradial PCI and maximal antiplatelet therapy, the incidence of major bleeding remains low. Major bleeding is an independent predictive factor of adverse acute and 1-year outcomes, regardless of the access site.