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Comparison of Bleeding Outcomes After Percutaneous Coronary Intervention in Patients With Versus Without Aortic Stenosis.

MedStar author(s):

Chen, Fang

Fatemi, Omid

Citation: American Journal of Cardiology. 116(7):1106-9, 2015 Oct 1.PMID: 26256579Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Randomized Controlled TrialSubject headings: *Aortic Valve Stenosis/co [Complications] | *Coronary Artery Disease/su [Surgery] | *Percutaneous Coronary Intervention/ae [Adverse Effects] | *Postoperative Hemorrhage/ep [Epidemiology] | Age Factors | Aged | Coronary Artery Disease/co [Complications] | District of Columbia/ep [Epidemiology] | Female | Follow-Up Studies | Humans | Incidence | Male | Postoperative Hemorrhage/et [Etiology] | Retrospective Studies | Risk Factors | Sex FactorsLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

1879-1913

Name of journal: The American journal of cardiologyAbstract: Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS. Copyright � 2015 Elsevier Inc. All rights reserved.All authors: Chen F, Fatemi O, Gai J, Huffman C, Pichard A, Satler L, Suddath W, Torguson R, Waksman RDigital Object Identifier:

http://dx.doi.org/10.1016/j.amjcard.2015.07.021

Date added to catalog: 2016-01-15

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		26256579

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS. Copyright � 2015 Elsevier Inc. All rights reserved.

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