Published online before print May 8, 2009, doi: 10.1161/CIRCINTERVENTIONS.108.846741
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Original Articles |
Bleeding in Patients Undergoing Percutaneous Coronary Intervention
The Development of a Clinical Risk Algorithm From the National Cardiovascular Data Registry
From the Division of Cardiovascular Research, Mid America Heart Institute (S.K.M., A.D.F., J.B.L., J.A.H., J.A.S., S.P.M.), Saint Luke’s Hospital, Kansas City, Mo; and Duke Clinical Research Institute (S.V.R., F.-S.O., M.T.R., E.D.P.), Durham, NC.
Correspondence to Steven P. Marso, MD, Mid America Heart Institute, Saint Luke’s Hospital, University of Missouri Kansas City, 4401 Wornall Road, Kansas City, MO 64111. E-mail smarso{at}saint-lukes.org
Received December 22, 2008; accepted April 20, 2009.
Background— Bleeding in patients undergoing percutaneous coronary intervention (PCI) is associated with increased morbidity, mortality, length of hospitalization, and cost. We identified baseline clinical characteristics associated with bleeding complications after PCI and developed a simplified, clinically useful algorithm to predict patient risk.
Methods and Results— Data were analyzed from 302 152 PCI procedures performed at 440 US centers participating in the National Cardiovascular Data Registry. As defined by the National Cardiovascular Data Registry, bleeding required transfusion, prolonged hospital stay, and/or a drop in hemoglobin >3.0 g/dL from any location, including percutaneous entry site, retroperitoneal, gastrointestinal, genitourinary, and other/unknown location. Bleeding complications occurred in 2.4% of patients. From the best-fitting model consisting of 15 clinical elements associated with post-PCI bleeding in a random 80% training cohort, we developed a parsimonious risk algorithm. Predictors of bleeding included age, gender, previous heart failure, glomerular filtration rate, peripheral vascular disease, no previous PCI, New York Heart Association/Canadian Cardiovascular Society Functional Classification class IV heart failure, ST-elevation myocardial infarction, non–ST-elevation myocardial infarction, and cardiogenic shock. The parsimonious model was validated in the remaining 20% of the population (c-statistic, 0.72) and in clinically relevant subgroups of patients. This simplified model was used to derive a clinical risk algorithm, with larger numbers corresponding with greater risk. In 3 categories, bleeding rates were greater in patients with higher estimates (
7, 0.7%; 8 to 17, 1.8%; 
18, 5.1%).
Conclusions— This report identifies baseline clinical factors associated with bleeding and proposes a clinically useful algorithm to estimate bleeding risk. This model is potentially actionable in altering therapeutic decision making and improving outcomes in patients undergoing PCI.
Key Words: catheterization • hemorrhage • risk factors
CLINICAL PERSPECTIVE
The online-only Data Supplement is available at http://circinterventions.ahajournals.org/cgi/content/full/10.1161/CIRCINTERVENTIONS.108.846741/DC1.