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Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI

BACKGROUND: Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Prevention of access-site MB has received significant attention. However, limited data have been obtained o...

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Autores principales: Thibert, Michael J., Fordyce, Christopher B., Cairns, John A., Turgeon, Ricky D., Mackay, Martha, Lee, Terry, Tocher, Wendy, Singer, Joel, Perry-Arnesen, Michele, Wong, Graham C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347846/
https://www.ncbi.nlm.nih.gov/pubmed/34401693
http://dx.doi.org/10.1016/j.cjco.2021.02.009
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author Thibert, Michael J.
Fordyce, Christopher B.
Cairns, John A.
Turgeon, Ricky D.
Mackay, Martha
Lee, Terry
Tocher, Wendy
Singer, Joel
Perry-Arnesen, Michele
Wong, Graham C.
author_facet Thibert, Michael J.
Fordyce, Christopher B.
Cairns, John A.
Turgeon, Ricky D.
Mackay, Martha
Lee, Terry
Tocher, Wendy
Singer, Joel
Perry-Arnesen, Michele
Wong, Graham C.
author_sort Thibert, Michael J.
collection PubMed
description BACKGROUND: Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Prevention of access-site MB has received significant attention. However, limited data have been obtained on the influence of access-site MB vs non-access-site MB and association with subsequent adverse in-hospital outcomes in the STEMI population undergoing pPCI. METHODS: We identified 1494 STEMI patients who underwent pPCI between 2012 and 2018. Unadjusted and adjusted differences among patients with no MB, access-site MB, non-access-site MB, and in-hospital clinical outcomes were assessed. The use of bleeding-avoidance strategies and their effects on MB were also evaluated. RESULTS: MB occurred in 121 (8.1%) patients. Access-site MB occurred in 34 (2.3%) patients, and non-access-site MB occurred in 87 (5.8%). The median reduction in hemoglobin was 31 g/L (interquartile range: 19-43) with access-site MB, and 44 g/L (interquartile range: 29-62) with non-access-site MB. After multivariable adjustment, non-access-site MB was independently associated with in-hospital death (adjusted odds ratio [aOR] 4.21; 95% confidence interval [CI] 2.04-8.68), cardiogenic shock (aOR 10.91; 95% CI 5.67-20.98), and cardiac arrest (aOR 5.63; 95% CI 2.88-11.01). Conversely, access-site MB was not associated with adverse in-hospital outcomes. Bleeding-avoidance strategies were used frequently; however, after multivariable adjustment, no single bleeding-avoidance strategy was significantly associated with reduced MB. CONCLUSIONS: In STEMI patients undergoing pPCI, non-access-site MB was independently associated with adverse in-hospital outcomes, whereas access-site MB was not. Additional study of strategies to reduce the incidence and impact of non-access-site MB appears to be warranted.
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spelling pubmed-83478462021-08-15 Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI Thibert, Michael J. Fordyce, Christopher B. Cairns, John A. Turgeon, Ricky D. Mackay, Martha Lee, Terry Tocher, Wendy Singer, Joel Perry-Arnesen, Michele Wong, Graham C. CJC Open Original Article BACKGROUND: Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Prevention of access-site MB has received significant attention. However, limited data have been obtained on the influence of access-site MB vs non-access-site MB and association with subsequent adverse in-hospital outcomes in the STEMI population undergoing pPCI. METHODS: We identified 1494 STEMI patients who underwent pPCI between 2012 and 2018. Unadjusted and adjusted differences among patients with no MB, access-site MB, non-access-site MB, and in-hospital clinical outcomes were assessed. The use of bleeding-avoidance strategies and their effects on MB were also evaluated. RESULTS: MB occurred in 121 (8.1%) patients. Access-site MB occurred in 34 (2.3%) patients, and non-access-site MB occurred in 87 (5.8%). The median reduction in hemoglobin was 31 g/L (interquartile range: 19-43) with access-site MB, and 44 g/L (interquartile range: 29-62) with non-access-site MB. After multivariable adjustment, non-access-site MB was independently associated with in-hospital death (adjusted odds ratio [aOR] 4.21; 95% confidence interval [CI] 2.04-8.68), cardiogenic shock (aOR 10.91; 95% CI 5.67-20.98), and cardiac arrest (aOR 5.63; 95% CI 2.88-11.01). Conversely, access-site MB was not associated with adverse in-hospital outcomes. Bleeding-avoidance strategies were used frequently; however, after multivariable adjustment, no single bleeding-avoidance strategy was significantly associated with reduced MB. CONCLUSIONS: In STEMI patients undergoing pPCI, non-access-site MB was independently associated with adverse in-hospital outcomes, whereas access-site MB was not. Additional study of strategies to reduce the incidence and impact of non-access-site MB appears to be warranted. Elsevier 2021-02-16 /pmc/articles/PMC8347846/ /pubmed/34401693 http://dx.doi.org/10.1016/j.cjco.2021.02.009 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Thibert, Michael J.
Fordyce, Christopher B.
Cairns, John A.
Turgeon, Ricky D.
Mackay, Martha
Lee, Terry
Tocher, Wendy
Singer, Joel
Perry-Arnesen, Michele
Wong, Graham C.
Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title_full Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title_fullStr Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title_full_unstemmed Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title_short Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI
title_sort access-site vs non-access-site major bleeding and in-hospital outcomes among stemi patients receiving primary pci
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347846/
https://www.ncbi.nlm.nih.gov/pubmed/34401693
http://dx.doi.org/10.1016/j.cjco.2021.02.009
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