Abstract 13479: Contemporary Predictors of Post-Procedural Bleeding Complications Among Patients Undergoing Percutaneous Coronary Intervention (PCI): Results from the National Cardiovascular Data Registry (NCDR)
Background: Bleeding is a common and potentially modifiable complication of PCI. Bleeding risk prediction models could support tailoring of interventions to minimize bleeding complications and support meaningful risk-adjusted site feedback.
Methods: Using detailed clinical data from 583,540 PCI procedures performed from 2/08 to 10/10 at 1066 NCDR participating centers, we updated the NCDR bleeding risk model. The model was then validated in an additional146,648 procedures. Post-PCI bleeding was defined as any of the following occurring within 72 hours after PCI: intracranial hemorrhage, cardiac tamponade, non-bypass surgery-related blood transfusion in patients with a pre-procedure hemoglobin ≥ 8 g/dl, or an absolute decrease in hemoglobin value of ≥ 3g/dl in patients with a pre-procedure hemoglobin ≤ 16 g/dl. Model discrimination and calibration were assessed in the overall population and among varied subgroups.
Results: Overall, post-PCI bleeding occurred in 5.74% of cases. The final model included 19 pre-PCI variables (Table). The overall model C-index was 0.77 in both the development and validation samples. The model had similar discriminatory value across subgroups such as males, females, the elderly, patients with diabetes, and patients with STEMI (c-index 0.704-0.775). The model was also well calibrated across the PCI risk spectrum.
Conclusion: The new NCDR bleeding risk model provides an accurate assessment of post-PCI bleeding risk and can both inform clinical decision-making and support risk-adjusted hospital comparisons.
- © 2011 by American Heart Association, Inc.