Factors associated with hematoma formation after PCI in patients with acute myocardial infarction

Abstract Introduction Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute myocardial infarction (AMI), offering rapid reperfusion and improved outcomes for patients with ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI). Although contemporary radial and femoral access techniques have enhanced procedural safety, vascular complications, particularly hematoma formation at the puncture site, remain among the most frequent adverse events. Their occurrence may be influenced by patient characteristics, access site selection, antithrombotic therapy, and the adequacy of post-procedural hemostasis. Objective To evaluate factors associated with hematoma formation in patients with AMI (STEMI and/or NSTEMI) undergoing PCI. Methodology This study assessed puncture-site hematomas after transradial or transfemoral PCI. Hematomas were measured and classified using the EASY system (grades I–V) and documented with ruler measurements and photographs at defined intervals. Patients were grouped into those with hematoma (n = 33) and without hematoma (n = 87). Results During the first four months of 2025, 120 patients admitted to the Cardiology Clinic with AMI (STEMI and/or NSTEMI) were included. Of these, 85 (70.8%) were male and 35 (29.2%) female. Transfemoral access was used in 78 patients (65%) and transradial access in 42 (35%). Hematomas occurred in 19 transfemoral patients (9 grade I, 6 grade II, 3 grade III, and 1 grade IV) and in 14 transradial patients (8 grade I, 2 grade II, and 2 grade III). Two patients required blood transfusion. In total, hematomas were observed in 33 patients (27.5%). As shown in Table 1, older age and female sex were associated with a higher risk of hematoma, whereas hypertension, diabetes, and dyslipidemia were not. Body mass index (BMI) and prior aspirin use showed no significant differences between groups. Hemoglobin levels were significantly lower on follow-up in the hematoma group, likely reflecting bleeding and inadequate hemostasis. Prasugrel and heparin use showed no significant association with hematoma occurrence; notably, prasugrel was more commonly used in patients without hematomas. These findings suggest that the hemostasis process itself may play a central role in hematoma development. Conclusions Hematoma formation following PCI in patients with AMI remains a relevant clinical complication, occurring in more than one-quarter of the studied population. Older age and female sex were the primary factors associated with increased hematoma risk. The observed reduction in hemoglobin among patients with hematoma highlights the importance of vigilant post-procedural monitoring. These findings underscore the crucial role of effective hemostasis in preventing vascular complications and suggest that optimizing hemostatic techniques may further enhance the safety of PCI.For image description, please refer to the figure legend and surrounding text. Images of hematomasFor image description, please refer to the figure legend and surrounding text.