Access and Non–Access Site Bleeding After Percutaneous Coronary Intervention and Risk of Subsequent Mortality and Major Adverse Cardiovascular Events

Abstract

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. 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.

Will Bivalirudin Have an Impact in Peripheral Vascular Interventions?

“…We agree with the authors' postulate that reduction in bleeding may well explain the differences in mortality and major adverse clinical events observed because excess bleeding has consistently been demonstrated to increase mortality hazard in other data sets. [8][9][10][11] In this analysis, the addition of GPI was infrequent and did not affect the overall study outcome, further strengthening the hypothesis that bivalirudin reduces significant bleeding in PVI. It is worth noting that, although the arterial access site was not evaluated in this study, the vast majority of PVI procedures involving lower extremity PAD are performed via transfemoral access.…”

Is It Time to Join the Cult?

“…This is important as it becomes increasingly recognized that nonaccess site bleeding is associated with a greater risk of mortality than access site bleeding, probably because it signals patient frailty. 20,21 The practice of TRA has assumed nearly cult-like status. Many interventional cardiologists have adopted the appellation radialist and there are even radialist groups on such social media as Facebook and YouTube and scholarly articles whose titles have adopted a nearly evangelical tone with terms such as "transform" and "convert."…”

Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage

“…[3][4] Female gender, low body surface area, chronic renal failure, use of glycoprotein IIb/IIIa inhibitors, presentation with acute myocardial infarction (MI), and high placement of the sheath (above the inferior epigastric artery) have been reported as the most significant risk factors for retroperitoneal hemorrhage in various studies. [5,6] Mortality rates following retroperitoneal hemorrhage remain high, 8.6% in those experiencing a bleeding episode versus 2.4% in contemporary clinical practice, which has led to the modification of procedure strategies aiming to reduce its incidence. [6,7,10] Transradial approach (TRA) for cardiac catheterization has consistently demonstrated significant reduction in bleeding and vascular complications as shown in multiple clinical trials [8][9][10] and has led to increasing adoption of TRA worldwide.…”

“…[5,6] Mortality rates following retroperitoneal hemorrhage remain high, 8.6% in those experiencing a bleeding episode versus 2.4% in contemporary clinical practice, which has led to the modification of procedure strategies aiming to reduce its incidence. [6,7,10] Transradial approach (TRA) for cardiac catheterization has consistently demonstrated significant reduction in bleeding and vascular complications as shown in multiple clinical trials [8][9][10] and has led to increasing adoption of TRA worldwide. In the United States, the adoption of TRA has lagged overall and now is estimated at 30% of all diagnostic and PCI procedures performed.…”