- 作者：Sumeet Subherwal ; MD ; MBA鈦?/sup> ; sumeet.subherwal@duke.edu ; Eric D. Peterson ; MD ; MPH鈦?/sup> ; David Dai ; PhD ; MS鈦?/sup> ; Laine Thomas ; PhD鈦?/sup> ; John C. Messenger ; MD&dagger ; ; Ying Xian ; MD ; PhD鈦?/sup> ; Ralph G. Brindis ; MD&Dagger ; ; Dmitriy N. Feldman ; MD§ ; ; Shaun Senter ; MD鈭?/sup> ; Lloyd W. Klein ; MD鈭?/sup> ; Steven P. Marso ; MD¶ ; ; Matthew T. Roe ; MD ; MHS鈦?/sup> ; Sunil V. Rao ; MD鈦?/sup>
- 关键词：bleeding ; catheterization ; outcomes
- 刊名：Journal of the American College of Cardiology
- 出版年：2012
- 期刊代码：201_07351097
- 类别：med
- 出版时间：22 May, 2012
- 卷：59
- 期：21
- 页码：1861-1869
- 文件大小：1314 K
Objectives
The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).Background
The impact of bleeding avoidance strategies on post-PCI bleeding rates over time is unknown.
Methods
Using the CathPCI Registry, we examined temporal trends in post-PCI bleeding from 2005 to 2009 among patients with elective PCI (n = 599,524), UA/NSTEMI (n = 836,103), and STEMI (n = 267,632). We quantified the linear time trend in bleeding using 3 sequential logistic regression models: 1) clinical factors; 2) clinical + vascular access strategies (femoral vs. radial, use of closure devices); and 3) clinical, vascular strategies + antithrombotic treatments (anticoagulant 卤 glycoprotein IIb/IIIa inhibitor [GPI]). Changes in the odds ratio for time trend in bleeding were compared using bootstrapping and converted to risk ratio.
Results
An approximate 20%reduction in post-PCI bleeding was seen (elective PCI: 1.4%to 1.1%; UA/NSTEMI: 2.3%to 1.8; STEMI: 4.9%to 4.5%). Radial approach remained low (<3%), and closure device use increased marginally from 44%to 49%. Bivalirudin use increased (17%to 30%), whereas any heparin + GPI decreased (41%to 28%). There was a significant 6%to 8%per year reduction in annual bleeding risk in UA/NSTEMI and elective PCI, but not in STEMI. Antithrombotic strategies were associated with roughly half of the reduction in annual bleeding risk: change in risk ratio from 7.5%to 4%for elective PCI, and 5.7%to 2.8%for UA/NSTEMI (both p <0.001).
Conclusions
The nearly 20%reduction in post-PCI bleeding over time was largely due to temporal changes in antithrombotic strategies. Further reductions in bleeding complications may be possible as bleeding avoidance strategies evolve, especially in STEMI.