Abstract 11411: Use of Bleeding Avoidance Strategies Lowers Mortality in High Risk Patients Undergoing Stenting
INTRO: Use of bleeding avoidance strategies (BAS), defined as procedural bivalirudin, transradial access, or femoral closure devices have been shown to lower risk of bleeding in patients undergoing percutaneous coronary intervention (PCI). Whether use of BAS confers a mortality benefit has not been well established.
METHODS: Patients undergoing PCI at four University of Pittsburgh Medical Center affiliated hospitals were enrolled in a hospital-based registry and followed prospectively beginning in October 2011. Patient characteristics, in-hospital events, and 6 month follow up recorded. Bleeding risk score based on National Cardiovascular Data Registry (NCDR) calculator.
RESULTS: Among 2178 consecutive patients undergoing PCI, the average age was 65.3 years, 68.6% were male, and 91.9% Caucasian. Indication for PCI was STEMI in 21.8%, unstable angina/NSTEMI in 44.9% and stable angina in 33.3%. A BAS was used in 86.6% of patients; specifically femoral access closure device in 26.1%, bivalirudin use in 21.3%, transradial access in 3.9%, and a combination in 35.4%. BAS use more likely in low bleeding risk patients (score <13) compared to patients with an intermediate-high bleeding (score ≥ 13)(91.1% vs. 83.0%, p=0.0001). Figure 1 illustrates that use of a BAS was associated with a less bleeding and conferred a mortality benefit only in higher risk patients. With adjustment for a propensity score for BAS, lower risk of mortality persisted with a hazard ratio of 0.39 (95% CI of 0.25-0.60; p=0.0001) for death when a BAS was used in intermediate-high risk patients.
CONCLUSION: Use of BAS is most often used in patients at low risk of bleeding in whom use is not clearly associated with improved outcomes. While BAS is less frequently used in intermediate-high risk patients, it is associated with lower bleeding events and also 6-month mortality. Use of bleeding avoidance strategy should be considered in patients who are eligible and at intermediate to high risk for adverse events.
- © 2013 by American Heart Association, Inc.