Baseline Bleeding Risk and Arterial Access Site Practice in Relation to Procedural Outcomes After Percutaneous Coronary Intervention

Mamas, Mamas A.; Anderson, Simon G.; Carr, Matthew; Ratib, Karim; Buchan, Iain; Sirker, Alex; Fraser, Douglas G.; Hildick-Smith, David; de Belder, Mark; Ludman, Peter F.; Nolan, James

Abstract

Background
Transradial access (TRA) has been associated with reduced access site–related bleeding complications and mortality after percutaneous coronary intervention (PCI). It is unclear, however, whether these observed benefits are influenced by baseline bleeding risk.

Objectives
This study investigated the relationship between baseline bleeding risk, TRA utilization, and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database.

Methods
Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in 348,689 PCI procedures performed between 2006 and 2011. Four categories for bleeding risk were defined for the modified Mehran risk score (MMRS): low (<10), moderate (10 to 14), high (15 to 19), and very high (≥20). The impact of baseline bleeding risk on 30-day mortality and its relationship with access site were studied.

Results
TRA was independently associated with a 35% reduction in 30-day mortality risk (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.59 to 0.72]; p < 0.0001), with the magnitude of mortality reduction related to baseline bleeding risk (MMRS <10, OR: 0.73 [95% CI: 0.62 to 0.86]; MMRS ≥20, OR: 0.53 [95% CI: 0.47 to 0.61]). In patients with an MMRS <10, TRA was used in 71,771 (43.2%) of 166,083 PCI procedures; TRA was used in 8,655 (40.1%) of 21,559 PCI procedures in patients with an MMRS ≥20, illustrating that TRA was used less in those at highest risk from bleeding complications (p < 0.0001).

Conclusions
TRA was independently associated with reduced 30-day mortality, and the magnitude of this effect was related to baseline bleeding risk; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI.

Citation

Mamas, M. A., Anderson, S. G., Carr, M., Ratib, K., Buchan, I., Sirker, A., Fraser, D. G., Hildick-Smith, D., de Belder, M., Ludman, P. F., & Nolan, J. (2014). Baseline Bleeding Risk and Arterial Access Site Practice in Relation to Procedural Outcomes After Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 64(15), 1554-1564. https://doi.org/10.1016/j.jacc.2014.05.075

• Journal Article Type: Article
• Acceptance Date: May 13, 2014
• Online Publication Date: Oct 6, 2014
• Publication Date: 2014-10
• Deposit Date: Nov 29, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Electronic ISSN: 1558-3597
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: 15
• Pages: 1554-1564
• DOI: https://doi.org/10.1016/j.jacc.2014.05.075
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://keele-repository.worktribe.com/output/651625
• Additional Information: This article is maintained by: Elsevier; Article Title: Baseline Bleeding Risk and Arterial Access Site Practice in Relation to Procedural Outcomes After Percutaneous Coronary Intervention; Journal Title: Journal of the American College of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jacc.2014.05.075; Content Type: article; Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.