Abstract 10975: Association Between Periprocedural Bleeding and Long-term Mortality after Percutaneous Coronary Intervention in the Elderly: A Report from the National Cardiovascular Data Registry (NCDR)®
Background: Post-hoc analyses of clinical trial data have shown a relationship between hemorrhagic complications and adverse outcomes after PCI. PCI registries provide data on periprocedural bleeding complications but the utility of these measures in predicting outcomes has not been assessed comprehensively.
Methods: Patients aged > 65 years entered into the NCDR CathPCI Registry® were linked with claims from the Centers for the Medicare and Medicaid Services (CMS) to examine 30-day, 6-month, and 1-year mortality by the occurrence of an in-hospital bleeding event defined according to the NCDR® definition. The association between in-hospital bleeding and 1-year mortality was examined with Cox regression that included patient and procedure characteristics using no bleeding as the reference.
Results: 200,036 patients entered into the NCDR® between 2005 and 2006 were linked with CMS claims. 6364 (3.18%) experienced an in-hospital bleeding event. Patients who bled were older, more often female, had more medical comorbidities, less often received bivalirudin, and more often underwent femoral vs. radial approach. The rates of 30-day, 6-month, and 1-year mortality by the occurrence of a bleeding event are listed in the Table. After adjustment for patient and procedure factors using the validated NCDR® risk adjusment model, there was a significant association between in-hospital bleeding and 1-year mortality [hazard ratio (95% confidence interval), 1.26 (1.19–1.34)].
Conclusions: In this large contemporary registry of patients undergoing PCI in clinical practice, in-hospital bleeding as defined by the NCDR® was associated with increased short- and long-term mortality. These data demonstrate the prognostic value of the NCDR® bleeding definition and underscore the importance of reducing procedural bleeding risk.
- © 2010 by American Heart Association, Inc.