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Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis.

Publication ,  Journal Article
Kwok, CS; Khan, MA; Rao, SV; Kinnaird, T; Sperrin, M; Buchan, I; de Belder, MA; Ludman, PF; Nolan, J; Loke, YK; Mamas, MA
Published in: Circ Cardiovasc Interv
April 2015

BACKGROUND: The prognostic impact of site-specific major bleeding complications after percutaneous coronary intervention (PCI) has yielded conflicting data. The aim of this study is to provide an overview of site-specific major bleeding events in contemporary PCI and study their impact on mortality and major adverse cardiovascular event outcomes. METHODS AND RESULTS: We conducted a meta-analysis of PCI studies that evaluated site-specific periprocedural bleeding complications and their impact on major adverse cardiovascular events and mortality outcomes. A systematic search of MEDLINE and Embase was conducted to identify relevant studies and random effects meta-analysis was used to estimate the risk of adverse outcomes with site-specific bleeding complications. Twenty-five relevant studies including 2,400,645 patients that underwent PCI were identified. Both non-access site (risk ratio [RR], 4.06; 95% confidence interval [CI], 3.21-5.14) and access site (RR, 1.71; 95% CI, 1.37-2.13) related bleeding complications were independently associated with an increased risk of periprocedural mortality. The prognostic impact of non-access site-related bleeding events on mortality related to the source of anatomic bleeding, for example, gastrointestinal RR, 2.78; 95% CI, 1.25 to 6.18; retroperitoneal RR, 5.87; 95% CI, 1.63 to 21.12; and intracranial RR, 22.71; 95% CI, 12.53 to 41.15. CONCLUSIONS: The prognostic impact of bleeding complications after PCI varies according to anatomic source and severity. Non-access site-related bleeding complications have a similar prevalence to those from the access site but are associated with a significantly worse prognosis partly related to the severity of the bleed. Clinicians should minimize the risk of major bleeding complications during PCI through judicious use of bleeding avoidance strategies irrespective of the access site used.

Duke Scholars

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

April 2015

Volume

8

Issue

4

Location

United States

Related Subject Headings

  • Survival Analysis
  • Risk
  • Postoperative Hemorrhage
  • Percutaneous Coronary Intervention
  • Humans
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kwok, C. S., Khan, M. A., Rao, S. V., Kinnaird, T., Sperrin, M., Buchan, I., … Mamas, M. A. (2015). Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis. Circ Cardiovasc Interv, 8(4). https://doi.org/10.1161/CIRCINTERVENTIONS.114.001645
Kwok, Chun Shing, Muhammad A. Khan, Sunil V. Rao, Tim Kinnaird, Matt Sperrin, Iain Buchan, Mark A. de Belder, et al. “Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis.Circ Cardiovasc Interv 8, no. 4 (April 2015). https://doi.org/10.1161/CIRCINTERVENTIONS.114.001645.
Kwok, Chun Shing, et al. “Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis.Circ Cardiovasc Interv, vol. 8, no. 4, Apr. 2015. Pubmed, doi:10.1161/CIRCINTERVENTIONS.114.001645.
Kwok CS, Khan MA, Rao SV, Kinnaird T, Sperrin M, Buchan I, de Belder MA, Ludman PF, Nolan J, Loke YK, Mamas MA. Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis. Circ Cardiovasc Interv. 2015 Apr;8(4).

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

April 2015

Volume

8

Issue

4

Location

United States

Related Subject Headings

  • Survival Analysis
  • Risk
  • Postoperative Hemorrhage
  • Percutaneous Coronary Intervention
  • Humans
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology