Bleeding Linked to Cardiovascular Events After PCI

Death, heart attack and stroke more likely in patients with substantial periprocedural bleeding

07 april 2009-- Bleeding complications associated with percutaneous coronary intervention (PCI) may raise the risk of adverse outcomes in patients, according to research published in the April 1 issue of the American Journal of Cardiology.

Jasper Jan Brugts, M.D., of the Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues analyzed data from nearly 7,000 patients who underwent PCI. The authors classified patients by their periprocedural bleeding status (none, mild, moderate and severe) and assessed the outcomes of all-cause mortality and a composite of death, myocardial infarction or stroke. Subjects were followed for a median of 210 days.

The researchers found that in multivariate analysis, moderate and severe bleeding was associated with a higher risk of the composite outcome (hazard ratios, 2.38 and 3.55, respectively). Severe bleeding was associated with a higher risk of all-cause mortality (hazard ratio, 20.86). The need for blood transfusion was also associated with the composite endpoint (hazard ratio, 2.61), the report indicates.

"Three pathophysiologic mechanisms might explain the association among PCI, bleeding and death. First, periprocedural bleeding complications may be related to systemic inflammatory processes that increase the risk of subsequent thrombosis. Second, periprocedural bleeding or bleeding soon after PCI might lead to early cessation of dual-anti-platelet therapy, which was associated with increased cardiovascular events. Third, periprocedural bleeding led to blood transfusions that might themselves lead to increased cardiovascular risk," the authors conclude.

Abstract
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