Author + information
- Craig Strauss,
- Brandon Porten,
- Ivan Chavez,
- Jeffrey Chambers,
- Kenneth Baran,
- Anil Poulose and
- Timothy Henry
Peri-procedural bleeding is common during percutaneous coronary intervention (PCI) and increases length of stay (LOS), costs, and mortality. A validated pre-PCI bleeding risk score accurately identifies high-risk patients, providing an opportunity to employ bleeding avoidance strategies (BAS) to improve outcomes.
We implemented a pre-PCI real time decision support tool using a validated bleeding risk score (JAMA 2010;303(21):2156-64) at 3 high volume PCI centers. Pre-PCI risk scores were calculated and grouped as low (0-7), intermediate (8-17), and high (18+) risk. Consensus BAS included bivalirudin use in high-risk cases. Complications, red blood cell transfusions, bleeding within 72 hours, mortality, LOS, and variable costs were compared pre (July-December 2009) versus post (August-September 2012) protocol implementation.
Among 2,608 PCI cases (1,970 pre and 638 post), 636 (24.4%) were high-risk. Bivalirudin use in high-risk patients increased post protocol (24.2% vs. 60.3%; p<0.001). Among high-risk patients, significant reductions in complications, bleeding events, and LOS were demonstrated post protocol (Figure). Reductions in transfusions, mortality, and variable costs were also observed.
Implementation of a real time decision support tool to identify high bleeding risk patients and guide selective use of BAS successfully changed practice patterns and achieved significant reductions in complications, bleeding events, and LOS.
West, Room 3006
Sunday, March 10, 2013, 8:30 a.m.-8:45 a.m.
Session Title: Advancing the Cutting Edge of Cardiovascular Care: Recent Accomplishments and Future Goals
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 920-5
- 2013 American College of Cardiology Foundation