Author + information
- Bhaskar Bhardwaj1,
- John Spertus2,
- Kevin Kennedy3,
- Schuyler Jones4,
- David Safley3,
- Thomas Tsai5,
- Herbert Aronow6,
- Amit Vora7,
- Yashashwi Pokharel8,
- Robert R. Attaran9,
- Dmitriy Feldman10 and
- Adam Salisbury2
- 1UMKC, Kansas City, Missouri, United States
- 2Mid America Heart Institute, Kansas City, Missouri, United States
- 3University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 4Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States
- 5Institute for Health Research, Kaiser Permanente Denver, Lafayette, United States
- 6Lifespan Cardiovascular Inst, Providence, Rhode Island, United States
- 7Duke University, Durham, North Carolina, United States
- 8Saint Lukes Mid Amrica Heart Institute, Kansas City, Missouri, United States
- 9Yale University, New Haven, Connecticut, United States
- 10Weill Cornell Medical Center, New York, New York, United States
Peri-procedure PCI bleeding is associated with increased mortality and is potentially preventable, but few studies have examined bleeding complications in lower extremity peripheral vascular interventions (PVI).We examined the prevalence of major bleeding, patient characteristics associated with bleeding, and in-hospital outcomes after bleeding events in the NCDR PVI registry.
We studied all patients who underwent lower extremity PVI at 76 hospitals in the NCDR PVI registry from 2014 to 2016. Major bleeding complications were defined as: any overt bleeding with a hemoglobin (Hb) drop of ≥ 3g/dl, any Hb decline of ≥4g/dl, or any bleed requiring blood transfusion or intervention at the bleeding site within 72 hours of procedure in patients with pre-procedure Hb >8 g/dl. Multivariable logistic regression was used to identify patient factors independently associated with bleeding.
Of 18,393 patients in the registry, bleeding events occurred in 751 (4%), 49% with overt bleeding and a 3g/dl drop in Hb and 33% with a 4g/dl Hb drop. Patients with urgent/emergent indications for PVI had more bleeding events when compared with elective procedures (10.4% vs 2.9% OR: 3.60, CI: (2.98- 4.34) p< 0.001). Independent predictors of bleeding were female sex, prior MI or heart failure, non-elective procedures and non-femoral access (Figure). All-cause in-hospital mortality was higher in patients who experienced bleeding events than those who didn't (6.6 % vs 0.3% OR: 11.57 CI: (7.53-17.77) p< .001).
Major bleeding occurred in ∼ 4% of lower extremity PVI procedures, and was more frequent among women, patients with prior MI or heart failure, non-elective procedures and non-femoral access. Moreover, major bleeding was associated with a significantly higher risk of in-hospital mortality. Further studies are needed to identify strategies to reduce risk of bleeding during and after lower extremity PVI.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention