Author + information
- Nanda Iryuza1,
- Sunarya Soerianata1,
- Dafsah Arifa Juzar1,
- Wishnu Aditya Widodo1,
- Doni Firman1,
- Nur Haryono1 and
- Amir Aziz Alkatiri1
STEMI is a fatal manifestation of acute coronary syndrome. Reperfusion therapy is indicated for acute STEMI patients within less than 12 hours onset of chest pain. Bleeding is an independent mortality risk as a complication of primary PCI. Major bleeding worsens the prognosis, prolong the length of hospital stay, and increase the cost of care. Nowadays, trans-radial access during primary PCI is a priority and the use of Gp2b3a inhibitor is no longer used routinely. However, post-primary PCI bleeding event nonetheless tripled the risk of death.
1035 post trans-radial primary PCI of STEMI patients enrolled from a cohort retrospective study performed in National Cardiovascular Center Harapan Kita between January 2011 and August 2016. BARC bleeding definition was utilized to standardize the identification of in-hospital bleeding events. Statistical analysis was performed by conducting survival analysis to the enrolled cases in 2 years period.
In the non-in-hospital bleeding group, followed-up for 2 years showed a survival rate of 96.9%, compared with the group who experienced bleeding during hospitalization (83.7%). The mean survival time for a non-bleeding group was 101 weeks, while a bleeding group was 91 weeks. Cox regression analysis was performed with a significant result (p<0.001). The hazard ratio (HR) for the bleeding group showed that bleeding event may results in 4.6 times earlier mortality compared to the non-bleeding group (95% CI 1.7–12.3). Other factors that associated with mortality were KILLIP class with HR 2.9 (95% CI 1.1–8.1), and high WBC with HR 2.2 (95% CI (1.1–4.6).
The in-hospital bleeding event associated with higher and earlier mortality events in 2 years post trans-radial primary PCI. Clinical presentation of KILLIP class 3-4 and high WBC are strongly associated with post-discharge mortality.