Major bleeding (BARC groups 3&5) after percutaneous coronary intervention was independently associated with an increased risk of in-hospital and 30-day MACCE (OR 4.37).
Cohort (n=37,866)
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Does increasing bleeding severity (BARC) predict in-hospital and 30-day MACCE in patients undergoing PCI?
Major bleeding (BARC 3 & 5) after PCI is strongly associated with increased short-term MACCE, highlighting the importance of bleeding mitigation strategies such as radial access and judicious antiplatelet use.
Odds Ratio: 4.37
Bleeding severity in patients undergoing percutaneous coronary intervention (PCI), defined by the Bleeding Academic Research Consortium (BARC), portends adverse prognosis. We analysed data from 37,866 Australian patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR), and investigated the association between increasing BARC severity and in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (a composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, or stroke). Independent predictors associated with major bleeding (BARC groups 3&5), and MACCE were also assessed. There was a stepwise increase in in-hospital and 30-day MACCE with greater severity of bleeding. Independent predictors of bleeding included female sex (Odds Ratio (OR) 1.34), age (OR 1.02), fibrinolytic therapy (OR 1.77), femoral access (OR 1.51), and ticagrelor (OR 1.42), all significant at the p < 0.001 level. Following adjustment of clinically important variables, BARC 3&5 bleeds (OR 4.37) were still predictive of cumulative in-hospital and 30-day MACCE. In conclusion, major bleeding is an uncommon but potentially fatal PCI complication and was independently associated with greater MACCE rates. Efforts to mitigate the occurrence of bleeding, including radial access and judicious use of potent antiplatelet therapies, may ameliorate the risk of short-term adverse clinical outcomes.
Murali et al. (Mon,) conducted a cohort in Percutaneous coronary intervention (PCI) (n=37,866). Major bleeding (BARC groups 3&5) vs. Lesser or no bleeding was evaluated on Cumulative in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (OR 4.37). Major bleeding (BARC groups 3&5) after percutaneous coronary intervention was independently associated with an increased risk of in-hospital and 30-day MACCE (OR 4.37).
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